From late January to early August of this year, 762 cases of measles were confirmed in West Texas, with 99 requiring hospitalization and two resulting in fatalities among children. It is heartbreaking that we have lost lives to the now easily-preventable measles, which had been eradicated in 2000 via vaccine programs. However, widespread vaccine skepticism, fueled by misinformation and declining trust in public health agencies, has reversed decades of progress. It is confusing and disheartening to see this regression. While the current issue of misinformation and divergent perceptions of objective reality is beyond the scope of this article, one practice that can reduce medical skepticism is known as epistemic humility.
Medicine is an art as well as a science. Anyone who has studied biochemistry has seen, to some degree, the complexity of the chemical reactions that happen in our cells. It can be difficult to predict how bioactive compounds will interact, let alone how they might affect any given individual. Considering how the human body consists of such a complex network of systems, how confident can you really be that you have found the cause of a set of surface-level symptoms? Since our knowledge of medicine continues to expand and evolve with the addition of new findings, medical professionals inevitably have to operate with a level of uncertainty. Professionals can only prescribe the best remedy they can, given their limited knowledge of the most up-to-date medical findings and the patient’s medical history and symptoms. It is important for clinicians to not only make sound judgments, but to also communicate them clearly and truthfully to patients.
A virtue that has gained recent traction is known as “epistemic humility”, which describes “claims that accurately portray the quality of evidence for believing the claim to be an accurate one.” Health care workers who practice epistemic humility recognize the limitations of their perspective and knowledge, are open to new evidence and ideas, and do not assume certainty when it is unwarranted. With the concerning level of skepticism towards modern medicine that has been growing in the United States, some may intuitively believe that doctors should reassure patients with unwarranted confidence. I, however, argue that the very opposite is true: in order to reduce bias and gain patient trust, doctors have an ethical obligation to practice epistemic humility.
One aspect of epistemic humility is accurately surveying the certainty of a claim. On a smaller scale, this could look like identifying the likelihood that a diagnosis is accurate. Physicians should present the certainty of their judgments to patients rather than demonstrate unwarranted confidence if they want to gain the trust of their patients. This not only strengthens patient-practitioner relationships but also reduces premature diagnostic closure, allowing clinicians to recognize that their initial conclusions may be fallible. On a larger scale, epistemic humility could mean accurately presenting and taking seriously the limitations of a clinical study. For instance, a study may report that a new antibiotic appears effective, but the trial included only a small sample size, excluded older adults, and used a follow-up period too short to detect long-term side effects. Researchers practicing epistemic humility would explain this in their paper, clearly acknowledging factors such as who was studied and what the study measured. This reinforces scientific integrity and prevents the overgeneralization of results by medical authorities.
Relational epistemic humility refers to the acknowledgment that your personal experiences are limited and may not be adequate to inform you about the experiences of another individual. A common experience that can cause people to become skeptical of medicine is when their testimony of their symptoms is not taken seriously. Practitioners should clearly demonstrate active listening to patients and approach patient testimony with an open mind. Over time, this would help cultivate a sense of safety, honesty, and openness with patients.
Another important benefit of practicing epistemic humility is that it addresses epistemic injustice, the unfair treatment of certain individuals’ testimonies due to personal and structural biases. In other words, epistemic injustice happens when traits such as gender and race affect whether someone’s expressed experiences are believed. This is an issue in medicine, since practitioners are under pressure to diagnose quickly, leading them to rely on statistical trends and social generalizations to determine how likely a patient’s testimony might be. Epistemic injustice leads to misdiagnosis and underdiagnosis, causing patients to deal with unsuitable treatment or a complete lack of treatment. It can also fuel self-doubt, leading patients to question their own experiences. Lastly, it skews diagnostic data, which causes a positive feedback loop in which prejudice continues to fuel even more prejudice.
This can be seen historically: women are frequently overdiagnosed with certain disorders including hysteria, BPD, and DID due to stereotypes about emotional instability, while men’s symptoms have often been downgraded and pathologized differently. Dr. Jerold Kreisman explains how in women, “impulsive, destructive behaviors may more often be attributed to illness that can be treated. In men, similar conduct may be seen as antisocial, where the only response is law enforcement.” Practitioners have allowed their personal biases on gender to influence their diagnosis of these disorders, so much so that the effects can be seen systematically. Additionally, the New England Journal of Medicine hosted a podcast that discussed race-based assumptions in medicine, specifically the idea that black Americans have reduced lung capacity, a racist idea that has survived since plantation medicine from the 19th century. This caused medical practitioners to apply a race-based correction to spirometry, leading black (and sometimes Asian) Americans to appear less sick than they are. Underdiagnosis leads to inadequate treatment, lower priority on lung-transplant waitlists, and reduced disability compensation. It was only in 2023 that hospitals adopted widespread race-neutral spirometry tests.
In order to help reduce these biases, practitioners should actively manage how they respond to the testimony of their patients, striving for objectivity. Doing so helps prevent unconscious biases from guiding who they believe and who they dismiss.
It could be argued that presenting epistemic humility to patients may have the opposite of the intended effect. Rather than build confidence, admitting when there is uncertainty may cause even more medical skepticism. After all, how do you trust that your doctor is competent if they express when they do not know something for sure? To counter this argument, I will point to the COVID-19 pandemic, in which insufficient humility among medical authorities contributed to skepticism and mistrust. In particular, WHO rapidly issued and updated mask guidelines 21 times over a time period of less than 3 years for healthcare workers and the general public. Early guidance relied on indirect evidence from other respiratory illnesses. As WHO conducted and incorporated new research using direct evidence from COVID-19, their guidelines became increasingly accurate. However, presenting certain guidelines as absolute before certainty was established forced medical authorities to appear to go back on their word. This created an image of overconfidence. This naturally led to public confusion and suspicion. Conspiracy theories about vaccines and treatments thrived, and some of the American public actively went against COVID-19 messaging. If authorities had openly acknowledged uncertainty from the start, perhaps the public would not have perceived them as inconsistent when recommendations evolved. Thus, the pandemic has served as a learning opportunity for medical authorities. Epistemic humility, not unfounded assurance, strengthens trust and communication with the public.
Amid growing skepticism towards modern medicine, it is easy to blame medical skepticism on lack of education and reason. On the contrary, there is some good reason, especially for certain demographics, to be doubtful of their doctors to an extent. By addressing biases and recognizing uncertainties, medical authorities can become more reliable and worthy of public trust. Saying “I don’t know” is not a weakness; it is a strength.