The Untapped Power of “We Don't Know”: Epistemological Humility in the Era of COVID-19, 2024, Kalinowski et al.

[SNT Gatchaman]

The Untapped Power of “We Don't Know”: Epistemological Humility in the Era of COVID-19
Jolaade Kalinowski; Elizabeth A. Hintz; Chigozirim Izeogu

The SARS-CoV-2 (COVID-19) pandemic introduced many challenges and nuances that have transformed medical practice and research. The uncertainty caused by COVID-19 led to inevitable challenges to patient–provider relationships. The ever-changing landscape of COVID-19 research and policy proved to be challenging for the medical community and patients. These challenges also exacerbated long-standing issues regarding patient–provider communication and trust.

On the other hand, these challenges gave voice to a burgeoning patient advocacy community. Through social media, advocacy and patient organizing, patients harnessed their power and organized over challenges relating to COVID-19 fears and concerns, ramifications of “Long COVID,” and much more. During this unprecedented pandemic, there was a realization that the science and research surrounding COVID-19 is evolving and that there may be a benefit to embracing the dynamic nature of research and the scientific process.

We propose that providers and the medical community should consider epistemological humility, which acknowledges insufficiencies related to the state of medical knowledge with a sense of understanding and respect for not having all of the answers. We argue that there is untapped potential in saying, “We don’t know” and explaining why. There is an implicit culture that providers should be responsible for knowing everything and solving every problem. Epistemological humility challenges this culture, and inherently gives credence and voice to patient perspectives. We assert that epistemological humility is necessity when addressing contemporary health challenges such as COVID-19.

Link | PDF (Journal of Patient Experience) [Open Access]

 

[SNT Gatchaman]

The challenges of COVID-19 research happening in real time has brought about many consequences including medical misinformation and poor patient–provider communication.

Building on prior research, we define epistemological humility as the acknowledgement of insufficiencies related to the state of medical knowledge in general. Put simply, we assert that there is untapped potential in saying, “We don’t know” and explaining why. This is distinct from admitting “I don’t know,” which refers to the lack of knowledge of an individual.

We recognize that this paradigm shift challenges previously established norms in medicine and research and poses inherent challenges.

Health disparities are pervasive and largely attributable to institutional racism, classism, and other forms of discrimination and prejudice. There are several arguments for how saying “We don’t know” might benefit patients. The absence of epistemological humility leaves an unacknowledged gap between patients’ lived experiences and the (lack of) medical knowledge about their illnesses. This gap leaves the provider vulnerable to bias. Racialized, gendered, classed notions about whose bodies are “really” sick may begin to prevail.

It is also important to humbly recognize how a long history of imbalanced power dynamics between patients and physicians and a lack of humility have perpetuated and exacerbated these disparities.

Epistemological humility offers providers the freedom from feeling obliged to act without acknowledging or considering the lack of knowledge and/or risks or benefits to a situation. Epistemological humility emphasizes that patients are the experts of their experience. Though we may not have the answers, we are merely admitting the limitations of the current state of knowledge in the field—not necessarily their own lack of knowledge. True epistemological humility reflects the distinction between the collective state of knowledge and an individual provider’s level of knowledge.

 

[rvallee]

I didn't keep some tally or anything, but roughly speaking, I'd say that most of the predictions I saw from medical experts about COVID were wrong. And sometimes completely so, even laughably. Too often despite there being more than enough data to know better.

Experts know a lot more, and better, about things that are known, but when it comes to predicting what will turn out to be true, they don't actually do much better than an average person given a 2 minute summary and some time to reflect on it. When there is nothing confirmed, they actually seem to do worse, because they get caught treating their own opinion as evidence in itself.

There's something driving this high level of being incorrectly wrong in health care. It's not random, it has to come from the culture and training because most experts respect the limits of their skills and knowledge as a default. So, obviously bad training has to be addressed, but who will do that? Who trains MDs on being sometimes confidently incorrect, if not other MDs who were taught this way? Who breaks the cycle? In a profession where traditions often overrule conflicting data?

You sometimes see experts talking about things, even making predictions, outside of their expertise and doing no better than chance. Only in medicine does it seem to be common about their actual topic of expertise. Probably having to do with there being zero consequences for it. Some of the people who were the worst predictors about the pandemic were the most commonly platformed ones, because clearly there is demand for it and it's good for their career to be prominently wrong.

And that's completely unique in all the professions, where usually getting one major prediction wrong is pretty much the last time it happens, because there are no other opportunities after that.

No other profession has an in-built power imbalance on all acts. It's probably where 99% of this happens. And there is no way to correct for that imbalance, the nature of health care, where secrecy reigns, doesn't allow it. It has to be ended, no matter how many people it makes raving mad. They'll get over it and it's for their own good anyway.

And "we don't know" is not actually a good answer if it doesn't happen with efforts to find out. In our case it's actually "we don't want to know", which as an outsider to medicine who was trained in an engineering profession is just completely baffling. The only scientists who don't want to know, who aren't curious for curiosity's sake, who even proclaim that knowledge is more dangerous to us than ignorance, because of the absurd psychosomatic ideology, sometimes anyway.

 

[Sean]

And "we don't know" is not actually a good answer if it doesn't happen with efforts to find out. In our case it's actually "we don't want to know",

+1