Addressing uncertainties about the effects of treatments
Where do we go from here? Clinicians need to be able to draw on resources that provide the best current evidence about a treatment, taken from collective experience and systematic reviews of any reliable research studies that exist.
If, after doing this, they find that uncertainty remains about a treatment, they need to be prepared to discuss this with their patients and to explain why this is so. Patients and clinicians can then discuss the options together, taking into account patient preferences. These discussions may raise further uncertainties that need to be acknowledged and addressed.
Only by recognizing together that uncertainties still exist, can steady progress be made towards making treatments more appropriate and safer. Uncertainty is therefore a prerequisite for progress, not an admission of ‘defeat’.
This positive attitude to addressing uncertainties is now reflected in some professional guidance. In the UK, the General Medical Council’s latest version of its Good Medical Practice guidance instructs doctors that, as part of maintaining and improving their performance, they ‘must help to resolve uncertainties about the effects of treatments’.
To do this, patients and clinicians must work together to design better research.