A Tolerance For Ambiguity*

Abstract

A student came to our program with a background in engineering—a field that is not characterized by ambiguity. She was struck by one of my comments on the first day of class and went home to tell her sister, a musician. Her sister titled a song and the CD “Tolerance for Ambiguity.”1 I had told the students that in their careers—beginning with their physical therapist education—they would have to develop a “high tolerance for ambiguity.” The musician's response to this was “wo[e], major, wo[e],” a phrase that continues to be echoed throughout our profession about the need to develop a tolerance for ambiguity. Perhaps the presence of ambiguity is related to independence in clinical decision making, growth of knowledge, and professional maturation. We didn't need a tolerance for ambiguity when we were told what to do. Now, ambiguity provides the context as we search for meaningful ways to identify the best examination procedure or the most effective intervention. First, we had to recognize and accept ambiguity. Now, we should be seeking knowledge to reduce that ambiguity. I began clinical practice in 1972. Then, a singular “proper” procedure was expected when working with patients in rehabilitation. The physician examined the patient, conducted the evaluation, and provided the therapists with a specific prescription. The prescription detailed each intervention—including the duration, frequency, and intensity of every aspect of that intervention. The therapist performed the prescribed intervention and reported progress at team meetings. Nothing was viewed as ambiguous. When I questioned the need for such specific “orders,” the chair of rehabilitation medicine reminded me that I was employed in a teaching hospital where the mission included training medical residents. The boundaries of my role in the plan of care were unquestionable. I railed at the chair's response, asking why someone like me—with a …