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December 2014

Clinical Uncertainty at the Intersection of Advancing Technology, Evidence-Based Medicine, and Health Care Policy

Author Affiliations
  • 1Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor
  • 2Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Surg. 2014;149(12):1221-1222. doi:10.1001/jamasurg.2014.382

Physicians are regularly challenged to make treatment recommendations for patients whose diagnosis and prognosis are uncertain and for whom the highest-quality evidence is inconclusive. Consequently, physicians are generally accustomed to functioning in the fog of uncertainty. Until now, the dynamics of clinical decisions in the midst of uncertainty have been left to physicians to manage in partnership with their patients.

This is about to change, however, under stipulations of the Affordable Care Act (ACA). Even as uncertainty persists, the ACA will exert pressure to measure quality in uniform ways that make winners and losers based on physicians’ different practice approaches. Nonetheless, to say that some physicians will be winners does not imply that patients will also win, particularly if newly established quality measures favor practice approaches that are ultimately proven inferior, with respect to patients’ outcomes.