All day long I work with patients who want answers and certainty. My awareness of how few questions have proven answers, and how unpredictable human health and disease can be, is a heavy burden. This discordance may be why I enjoyed Stuart Firestein’s excellent book, Ignorance, so much. He makes an excellent case for the value of ignorance.
For one thing, what passes for knowledge has a dark side: it is an end rather than a beginning. The more secure a ‘fact’ is, and the more firmly it is held to be beyond challenge, the greater the risk that it is not a platform for progress but a barrier to discovery. Think of how long scientific progress was blocked by the belief that the earth was the center of the universe, that fire was the release of Phlogiston, that heat was carried by a fluid called Caloric, that atoms were the smallest particles of matter.
We need to become comfortable with the fact that all our knowledge is tentative, all our answers provisional. Instead of seeking comfort and security in answers, we need to focus on the value and excitement of finding interesting questions. Medicine, like science, is not a linear and predictable process that moves inexorably towards a permanent truth. It is more like a search for a black cat in a dark room, with no guarantee that there is a cat in the room. Medicine, like science, depends more on asking the right questions than finding the right answers.
And, like both medicine and science, life is full of questions without answers. The key is not to focus on finding the right answers, but on asking the right questions. A good question helps us define our ignorance and ask more questions. An interesting question leads us somewhere and is connected to things that matter. Every answer should generate more questions. Every truth must be considered provisional, perhaps good enough for now, but always susceptible to revision. The harder we challenge our firmly held truths, the sooner we will find their flaws and develop better answers - which will, in turn, generate better questions.
We are fortunate to inhabit a universe where an unlimited supply of ignorance (and good questions) is guaranteed. Thanks to Gödel, we think we know that it is impossible to have a logical or mathematical system that is both complete and consistent. Thanks to Heisenberg, we think we know that the act of knowing something always means there is something else we cannot know. Just as there are sensory phenomena beyond our limits of perception, there are thoughts and concepts beyond our limits of understanding. Haldane said that the universe is not only stranger than we imagine, but stranger than we CAN imagine. (And Carlin pointed out that we can never know for sure what a deserted area looks like.)
We will never run out of things we do not know, but not knowing is not good enough. We need to pay attention to what we don’t know. We need to reflect, challenge and doubt so we can develop conscious ignorance.
In both life and in medicine, we need to embrace our ignorance and avoid settling for answers while we learn to ask better questions.