cancer, there was greater certainty--patients would die or go into remission. Unfortunately, the more we "progress," the more we must accept the uncertainty that is inherent to modern medical treatment. Indeed, uncertainty seems to be built into nature itself. As Einstein considered, but could not accept, God does play dice with the universe.
The selection of treatment is related to the standard of care. This standard is the criterion related to what is considered generally accepted medical practice on a regional or even national basis. The standard of care is not absolute but, rather, one that physicians have collectively agreed upon. Even to the extent that physicians are well-trained, alert, and adhere to the standard of care, this does not always guarantee that they will not harm the patient, nor even that they did the "right" thing, in retrospect. Medical uncertainty arises for three reasons: a lack of knowledge or understanding on the part of a specific individual, a lack of knowledge or understanding on the part of medicine itself, and the uncertainty associated with which of several possible treatments to employ. The third aspect of uncertainty is related to the huge expansion of medical knowledge since the 1950s and the proliferation of diagnostic technologies that overload physicians with information and possible alternatives. Physicians often have to analyze a huge amount of diagnostic information and select treatment from a range of options, often within a short period. Thus as medicine "progresses," the nature of uncertainty changes from understanding too little to understanding too much.
In the next chapter we will examine how the physicians and claimants I interviewed retrospectively defined their clinical context.