Trust does not require certainty. It requires honesty about uncertainty.

A friend of mine went to three specialists for a consult because her genetic predisposition put her at risk for cancer. Each of the specialists recommended a different care plan, and all three seemed confident about their prognosis. She actually wondered, how could the three expert clinicians be so certain when they disagree so fundamentally?

Over time, having been profoundly immersed in healthcare operations, I understand that reasonable experts can look at the same patient and arrive at different judgments — and the patient deserves to understand that uncertainty exists.

If there was one valuable learning from the pandemic, it is perhaps this: Changing one’s mind when evidence changes is not a failure of medicine. Pretending we knew more than we did… is!

Yet anyone who practices medicine knows that sometimes, “it depends” is often the most accurate answer we can give. “I don’t know” by itself can sound like incompetence. But “it depends — and here’s what it depends on…” sounds like expertise. A great physician doesn’t merely say, “I don’t know.” A great physician can say: “I don’t know for certain. Here’s what we know. Here’s what we don’t know. Here’s why I think. And here’s what matters to you as we decide what to do.”

That’s not weakness. That’s clinical maturity.

It comes down to the ability to listen for what the patient needs in that moment. There’s a huge difference between telling a frightened patient, “I don’t know,” and telling them: “There are things we don’t know yet. But I will help you navigate them.” The first can feel like being dropped. The second can feel like being accompanied.

Medicine doesn’t become less trustworthy when a physician admits its limits. It becomes more trustworthy when the physician helps the patient navigate through the limits.

Medicine is inherently uncertain. Pretending otherwise does patients a disservice. There is something very basic about all of this. Could physicians be honest about what they know — and what they don’t? This, I would say, is the sophisticated challenge. This also is something that could be labelled “going back to basics.” This, I believe, is pulling healthcare away from the institution and back toward the human being sitting in front of it.

So here’s the question. What does a patient do when three experts give three different answers — and all three sound absolutely certain?

Medical education teaches enormous amounts of knowledge. It teaches diagnosis, treatment, precision, decisiveness. The culture of medicine can understandably reward the person who has the answer.

But have we taught physicians equally well how to say, “Here is what we know — and here is where the uncertainty begins”?

We definitely don’t want our doctors walking around saying, “I don’t know.” Instead, this: “We don’t have a single right answer here. Let me explain why, what the choices involve, what I recommend, and what matters most in making the decision.”

That’s not uncertainty without leadership. That’s uncertainty with guidance.

Patients don’t all want the same thing from a physician. Some want certainty. Some want explanation. Some want authority. Some want partnership. Some want reassurance. And some, frankly, just want somebody to tell them what to do because they’re scared. The physician’s job isn’t to have the same conversation with every patient. It’s to listen well enough to know what conversation this patient needs, in a way that doesn’t compromise the truth.

Listen. Understand. Explain. Guide. Now that is a beautiful model for patient-centered care.

Yes. It’s time to retire the all-knowing physician. Not the physician. Not expertise. Not authority. The myth.

Patients deserve a physician who is honest about the limits of medicine — and committed enough to stay beside them while they navigate those limits.