Risk and Uncertainty, Medical decision making and risk management inspired by principles of mountaineers




  1. The state of being uncertain’ doubt; hesitancy.
  2. An instance of uncertainty, doubt, etc.
  3. Unpredictability; indeterminacy; indefiniteness.

(From: https://www.dictionary.com/browse/uncertainty)

Operating in uncertainty requires being willing to accept a degree of risk, and understanding the likelihood of failure in the task you have embarked upon. Medical professionals pride themselves on being knowledgeable to the point of virtually eliminating uncertainty and in being courageous enough to take on huge risks in the name of beneficence. Caught in the complex thoughts that allow clinicians the ability to balance benefits against risks, we commonly forget the pilots, coast guards, military captains, mountaineers and non-medical professionals also face uncertainties and are challenged with the task of minimizing risk in order to obtain the desired outcome. In fact, one could argue that we could learn a thing or two from these professionals who have operated in high stakes environments with arguably fewer resources, safety nets, and many more uncertainties and lots more at stake.

It was this insight that led Dr. Peter Laussen and his colleagues, to found the Risky Business conference in 2006 (https://www.riskybusiness.events/). This annual conference took place in Toronto earlier last week, and included professionals from diverse backgrounds presenting their approaches to managing risk and embracing the uncertainties they face every day. Their approaches focused on keeping others safe, contributing to science, and extending the limits of what is possible in their fields, all while staying alive themselves and ensuring the same for each and every member of their teams.

One of the talks that resonated the most for me, was the talk given by four mountaineers, all of whom had conquered numerous challenging summits with their teams and lived to talk about it. They were guided by the principle of establishing a shared mental model within their team to ensure everyone understood the risks and were aware of the hazards and uncertainties that inevitably surrounded their ascent. One of our own objectives at LaussenLabs, that of understanding and developing decision support algorithms based on analyzing and understanding physiological data, is to facilitate achieving a shared mental model, not just among the immediate clinicians caring for a specific patient, but also all those who play a role in the operation of a hospital at every level. It was incredible to realize that our goal too is inspired by a fundamental principle of mountaineering, and is in fact one which underlies the work of most high risk industries and endeavours.

Robert Greer

Author Robert Greer

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