Weber Ryan R, Caleb Amanda M
Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.
Teach Learn Med. 2025 Jun 19:1-8. doi: 10.1080/10401334.2025.2521002.
Uncertainty and disability are simultaneously well-studied and enigmatic conditions in medicine. Yet while uncertainty and disability have individually received significant attention, little mind has been paid to how they interact. Common assumptions and biases underscore the frequently negative view of both conditions. However, overemphasis on reducing and eliminating uncertainty has negatively impacted physicians beholden to a culture that venerates certainty. At the same time, medicine's focus on fixing and curing disability, which is founded on ableist practices and policies, has led to deleterious patient health outcomes. If what is required for equitable, person-centered care is a greater tolerance of uncertainty, then we might derive wider benefits from approaches with demonstrated efficacy in dismantling ableist logic. For this reason, we employ the social model of disability to formulate three interrelated strategies for reframing uncertainty as a source of possibility in clinical encounters and life more broadly. The first strategy entails reappraising mental models that have contributed to structural barriers. Applying Paul Han's framework for tolerance to pervasive sources of bias, we argue that reappraisal inhibits certainty preference from erasing the subjectivities that invigorate our collective wisdom and grant significance to our lived experiences. The second strategy involves reexamining ways of knowing that have controlled ways of being. By applying a critical lens to the labels and categories indispensable to contemporary knowledge systems, we illustrate how an ethics of uncertainty can help us realize the principles of epistemic justice. The third strategy involves replacing the "un-choosing of disability" as described by the disabled poet and activist Eli Clare with the reclaiming of uncertainty. This approach reveals how creating a medical culture that fosters meaning and purpose can positively influence the relational aspects of care. Collectively, these strategies form the foundation of a praxis necessary to foster tolerance of uncertainty and bodily variability throughout medicine. We conclude by demonstrating how leaning into the discomfort inherent to paradoxes can transform uncertainty from a limiting factor to a liberating force for epistemic justice.
在医学领域，不确定性和残疾既是经过充分研究的状况，又是神秘莫测的情况。然而，尽管不确定性和残疾各自都受到了极大关注，但它们之间如何相互作用却很少有人关注。常见的假设和偏见凸显了人们对这两种情况通常持有的负面看法。然而，过度强调减少和消除不确定性对那些受制于崇尚确定性文化的医生产生了负面影响。与此同时，医学专注于修复和治愈残疾，这建立在能力主义的实践和政策基础上，导致了对患者健康有害的结果。如果公平的、以患者为中心的护理需要对不确定性有更大的容忍度，那么我们或许可以从那些在拆解能力主义逻辑方面已证明有效的方法中获得更广泛的益处。出于这个原因，我们运用残疾的社会模型来制定三个相互关联的策略，以便在临床诊疗以及更广泛的生活中，将不确定性重新构建为可能性的来源。第一个策略需要重新评估那些导致结构性障碍的思维模式。应用保罗·汉关于容忍普遍存在的偏见来源的框架，我们认为重新评估能够抑制确定性偏好，避免其抹去那些激发我们集体智慧并赋予我们生活经历意义的主观性。第二个策略涉及重新审视那些控制存在方式的认知方式。通过以批判性视角审视当代知识体系不可或缺的标签和类别，我们阐明了不确定性伦理如何能帮助我们实现认知正义的原则。第三个策略涉及用对不确定性的重新掌控取代残疾诗人兼活动家伊莱·克莱尔所描述的“对残疾的回避”。这种方法揭示了创建一种能促进意义和目的的医学文化如何能对护理的人际关系方面产生积极影响。总体而言，这些策略构成了一种实践的基础，这种实践对于在整个医学领域培养对不确定性和身体差异的容忍度是必要的。我们通过展示如何直面悖论中固有的不适感，能将不确定性从一个限制因素转变为认知正义的解放力量来得出结论。
