Physicians routinely make decisions without knowing whether a treatment will work, how the disease will progress, or whether an intervention will ultimately benefit a patient. But the pressure to provide answers to their patients can make it difficult to acknowledge that sometimes, there are no clear answers.

Uncertainty can urge a doctor to order unnecessary testing and treatments; it can strain doctors’ relationships with their patients and ultimately take an emotional toll on physicians who are already dealing with complex ethical responsibilities. For Morten Magelssen, MD, PhD, professor and head of the Center for Medical Ethics at the University of Oslo in Oslo, Norway, uncertainty can complicate ethical decision-making.

Medscape News Europe spoke with Magelssen and three clinical researchers who have studied different dimensions of medical uncertainty to understand why it can be so difficult to manage and what physicians can do to lessen its burden.

When Treatment Becomes a Burden

Although clinicians are generally aware of the risks of overtreatment, recognizing when an intervention is unlikely to benefit a patient does not necessarily make the decision to withhold or withdraw it any easier. “I think the issue of overtreatment or futile care at the end of life is a perennial challenge that is relevant to many European physicians,” Magelseen said.

Intensive care, chemotherapy, and other interventions may offer little meaningful benefit when harms outweigh the potential gains. Treatment can prolong the final phase of life while exposing patients to severe symptoms, adverse effects, and low quality of life. 

But many factors can make potentially futile treatment difficult to avoid. “One important reason is medical uncertainty. You’d like to give the patient another chance of a cure or life extension, even though the chances of success are slim,” Magelssen said.

Patients or their relatives may also underestimate the severity of an illness or misunderstand the prognosis, leading them to pursue treatments whose burdens ultimately outweigh their benefits. Patients may also lack sufficient opportunities to express their concerns and preferences about end-of-life care, he explained.

For physicians, the inability to predict outcomes confidently can create considerable psychological strain. Research suggests that difficulty tolerating uncertainty can contribute to clinician distress and influence clinical decision-making. A 2025 study from the University Medical Center Hamburg in Hamburg and the University Medicine Greifswald in Greifswald, both in Germany, found an association between anxiety related to uncertainty in clinical practice and higher burnout scores. A 2023 systematic review from the University of Cologne in Cologne, Germany, and the Black Dog Institute in Sydney, Australia, found that uncertainty under stressful clinical conditions may contribute to the use of unproven treatments.

Learning to Live With Uncertainty

Bjørn Hofmann, PhD, MSc, professor and researcher in philosophy of medicine and ethics at the University of Oslo, has examined how different forms of uncertainty weigh on healthcare professionals. In a 2025 study, Hofmann identified six burdens associated with medical uncertainty: cognitive, emotional, behavioral, social, moral, and existential. Each calls for different responses:

• Cognitive burdens arise when physicians confront the limits of their knowledge. Acknowledging these limits openly, rather than presenting unwarranted certainty, can help clinicians communicate more effectively with patients.
• Emotional burdens, including anxiety, shame, and distress, may be relieved by discussing difficult experiences with colleagues rather than managing them in isolation.
• Behavioral burdens can emerge when uncertainty leads to excessive testing or treatment. Recognizing this tendency may help physicians avoid interventions that offer little benefit.
• Social burdens happen when uncertainty complicates communication and threatens trust. Transparency about what medicine can and cannot achieve may help preserve the physician-patient relationship.
• Moral burdens can follow difficult decisions and adverse outcomes. Self-acceptance and self-forgiveness may help clinicians recognize that even carefully considered decisions cannot guarantee favorable results.
• Existential burdens can challenge a physician’s sense of professional purpose. Refocusing on medicine’s fundamental goals — caring for patients, relieving suffering, and providing comfort — may offer a way forward when cure is no longer possible.

For Hofmann, acknowledging uncertainty is not a sign of professional weakness.

“Physicians may feel ashamed when being uncertain,” he told Medscape News Europe. “They can also feel devastation and remorse, which can also exacerbate other negative emotional responses.”

Being open about the limits of medical knowledge, while recognizing that uncertainty can also leave room for hope, may help ease these emotional burdens, he said.

When Emotions Become Part of Care

Physicians are often expected to remain composed during difficult consultations, but suppressing emotional responses may not always serve clinicians or their patients.

Sofia Zambrano, PhD, research group leader at the Institute of Social and Preventive Medicine at the University of Bern in Bern, Switzerland, has investigated how healthcare professionals experience and use emotions in clinical encounters. Her research suggests that emotions can play a constructive role in communication, particularly when physicians discuss serious illness and uncertain outcomes. Clinicians in the study described recognizing their emotional responses, reflecting on their meaning, and deciding whether expressing those feelings might help establish a connection with patients and relatives. Sometimes, that meant openly acknowledging an emotion. In other situations, clinicians used their emotional awareness internally to guide the conversation.

Those who used and shared emotions were more likely to perceive them as supporting authenticity, professional fulfillment, and protection against burnout. They also reported that emotional engagement could help patients and relatives feel understood and cared for, encourage them to express their own feelings, and foster a shared understanding of the clinical situation. Such engagement may be particularly important when patients and families are struggling to confront a serious diagnosis or prognosis.

However, Zambrano cautioned against turning emotional expression into another professional obligation. “Our research is not advocating that physicians perform particular emotions or that emotional expression should become another requirement that they have to fulfill during serious illness conversations,” she told Medscape News Europe.

Instead, the aim is to help clinicians recognize and respond thoughtfully to emotions that arise naturally. “If an emotion is genuinely present, the physician can notice it, reflect on what it means, and decide what would best serve the patient,” she said.

Structure Can Help Manage Uncertainty

Although self-awareness and communication skills can help physicians navigate uncertainty, clinicians cannot be expected to manage the emotional and ethical burdens of difficult care decisions without institutional support.

Vanessa Silva e Silva, PhD, associate professor and graduate program director at Brock University School of Nursing in St. Catharines, Ontario, has studied the pressures experienced by healthcare professionals involved in organ donation.

Her work highlights the importance of organizational structures that support clinicians before, during, and after ethically complex cases. “A consistent message across our studies is that individual coping is not enough on its own, and management and institutions should lead the development of support interventions,” she told Medscape News Europe.

• Before treatment: Interdisciplinary conversations should bring together physicians, nurses, and, where available, palliative care specialists, social workers, or spiritual care professionals. These conversations can help establish shared goals of care, clarify patient values, and define what a successful outcome would mean for the patient.
• During treatment, teams should revisit these goals regularly, especially when a patient’s condition changes. Nurses should have opportunities to raise concerns about suffering without being perceived as challenging the medical plan.
• After difficult cases, structured interdisciplinary debriefings can provide space for healthcare professionals to reflect on what happened and discuss their emotional responses.

Such approaches recognize that uncertainty is not solely an individual burden but one that requires communication and support across the healthcare team.

One of the most difficult tasks for physicians may be accepting that the quality of a clinical decision cannot always be judged by whether treatment succeeds. A patient may receive clear information, understand the likely benefits and burdens of an intervention, and choose a course of treatment consistent with their values, even when the outcome remains uncertain.

For Silva e Silva, supporting that decision is itself an important measure of ethical care. “Clinicians can hold themselves accountable for the quality of the conversation and the care they provide, not for an outcome they cannot control,” she said.

Magelssen, Hofmann, and Zambrano reported having no relevant financial relationships. Silva e Silva reported being the co-owner of VANAMI Research and Training.

Lisa Mulcahy is a freelance writer for WebMD and Medscape.

She is an internationally established health journalist whose credits include The Washington Post, Good Housekeeping, Prevention, Oprah Daily, Woman’s Day, Harper’s Bazaar, Elle, Marie Claire, Men’s Health, Los Angeles Times, Cosmopolitan, Glamour, Parade, Health, Self, Family Circle, and Seventeen. She also writes for many health organizations, including the American Heart Association and the National Multiple Sclerosis Society.

Mulcahy is an honors graduate of Brandeis University. She’s also the author of eight best-selling books, including The Essentials of Theater, an Amazon #1 top seller. Mulcahy has also enjoyed a career as an off-Broadway director/playwright/actress/singer.