Abstract

This chapter review and classify uncertainties in clinical medicine. Epistemic uncertainty is intimately linked to the relationship between theory, evidence, and knowledge. The relationships among observed, observable, and unobservable realities express uncertainties that can be characterized as a lack of knowledge about what is known (unknown knowns), what is known to be unknown (known unknowns), and not knowing what is unknown (unknown unknowns). Intimately linked with this classification of uncertainty is the psychological taxonomy that categorizes uncertainty based on knowledge of the external world and on our own state of knowledge. It is suggested that any attempt to develop a comprehensive treatise of uncertainty in clinical medicine must take into account the insights obtained from psychological research on uncertainty. Uncertainty can be effectively managed by explicitly recognizing its many sources, improving the quality of medical evidence, using better information technology tools, searching for sources of bias, and applying probability and decision theory to decisions under uncertainty.

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