Seely Andrew J
Division of Thoracic Surgery and Critical Care Medicine, 501 Smyth Road, Box 708, Ottawa Health Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
Perspect Biol Med. 2013 Winter;56(1):65-77. doi: 10.1353/pbm.2013.0009.
"Uncertainty" is the ongoing realization that we cannot predict the future, and "surprise" reminds us lest we forget. Despite the fact that uncertainty is an undeniable fact of everyday experiences, in particular when providing care to patients, it is ignored and under-evaluated scientifically. Understandably and appropriately, medical science seeks knowledge, certainty, and prediction; however, the fundamental truth of intrinsic irreducible uncertainty remains neglected. The principal hypothesis of this article is that greater acceptance and understanding of intrinsic uncertainty offers valuable insights towards improving the delivery and management of health care, as well as the performance of clinical and basic science research. This review highlights the ubiquitous presence and acceptance of irreducible uncertainty in diverse domains of science, defines and classifies uncertainty arising from this awareness, and explores the insights and implications of this understanding with regard to health-care practice, health-care management, physician-patient communication, basic science research, and clinical research. It offers specific recommendations in each area of focus that are proposed to stimulate deliberation and investigation.
“不确定性”指的是我们逐渐认识到无法预测未来，而“意外”则提醒我们不要忘记这一点。尽管不确定性是日常经历中不可否认的事实，尤其是在为患者提供护理时，但它在科学上却被忽视且评估不足。可以理解且合理的是，医学追求知识、确定性和预测；然而，内在不可简化的不确定性这一基本事实仍然被忽视。本文的主要假设是，对内在不确定性有更大程度的接受和理解，能为改善医疗保健的提供与管理以及临床和基础科学研究的表现提供有价值的见解。这篇综述强调了不可简化的不确定性在不同科学领域的普遍存在和接受情况，定义并分类了源于这种认知的不确定性，并探讨了这种理解在医疗实践、医疗管理、医患沟通、基础科学研究和临床研究方面的见解及影响。它在每个重点领域都提出了具体建议，旨在激发思考和调查。
