I looked at the bedside clock once again. It must have been the millionth time that night. I could not fall asleep. All my thoughts kept going back to a few days earlier, when a colleague of mine accused me of having delayed a diagnosis of cancer, and these accusations were expressed directly to the patient who, in turn, referred them to me. This news came out of the blue and was like a punch in my face. I searched deeply inside my brain and my conscience, trying to understand if I had had any kind of responsibility for what had happened to that patient. I started questioning my clinical work by breaking it down and smashing it into lots of small pieces, like a glass hit by an iron club. In our daily medical practice, we usually cling to scientific knowledge and evidence-based medicine, hoping that they might help us unravel the wool ball of uncertainty that we face. Sometimes during a tennis match, the ball hits the net and remains suspended in the air for an instant, leaving all who watch uncertain which side of the net it will fall on. Similarly, there are some situations in medicine where the risks and benefits are difficult to estimate; uncertainty reigns supreme; and only fate seems to determine which side of the court a patient’s outcome will fall on.

我再次看着床头的时钟。那一定是那天晚上的百万分之一。我无法入睡。我的所有想法一直追溯到几天前，当时我的一位同事指责我推迟了癌症的诊断，这些指控直接表达给了病人，病人又将他们转给了我。这则消息突如其来，就像我的拳头。我在大脑和良知中进行了深入的研究，试图了解我是否对该患者的病情负有任何责任。我开始质疑我的临床工作，方法是将其分解并粉碎成许多小块，例如铁棍击中的玻璃杯。在日常医学实践中，我们通常会坚持使用科学知识和循证医学，希望它们可以帮助我们解决我们面临的不确定性问题。有时在网球比赛中，球击中球网并保持悬浮在空中一瞬间，使所有观看者不确定球网落在球网的哪一侧。同样，在医学中有些情况下，其风险和收益难以估计；不确定性至高无上；并且只有命运似乎才能确定患者的结果将落在法院的哪一边。