Published on 23 October 2025

As a medical student, I was trained mainly within the biomedical model. The underlying assumption was that, with enough information gathered through a thorough history, examination, and appropriate investigations — and by applying sound clinical reasoning — a diagnosis could always be made. If uncertainty remained, the solution was simple: order more tests. The goal was certainty, rooted in the belief that there is an objective truth to be found, and little space was left for the subjective experience.

This way of thinking naturally led to increasing specialisation — the narrower the focus, the deeper the knowledge — in the ongoing quest for clarity and precision.

Yesterday, however, I was reminded again how elusive certainty can be.

A patient I know well came in, once more, with severe abdominal pain. She had undergone multiple endoscopies in the past, all of which had ruled out malignancy. This time, her latest results showed oesophagitis, and she had already received the appropriate treatment. Yet, despite this, she was still in agony — graphically describing her pain, again and again, pleading for more investigations. No explanation I offered could satisfy her. She wept in my room, desperate, saying she could no longer bear the pain. Something had to be done.

She recently lost her husband. I wondered quietly to myself whether her grief had lowered her pain threshold — my subjective truth. I prescribed pain relief and arranged a follow-up appointment. But when our consultation ended, she was still deeply unhappy, and I was left wondering how she would cope until next time.

Afterward, I felt drained. I walked over to the nurse practitioners I work with, looking for a bit of sympathy — and an extra-strong cup of rooibos tea. Had I missed something? Was there an undiagnosed medical condition I’d overlooked? Or was I right to see her pain through the lens of her grief — another expression of the loss she was struggling to carry?

I will have to live with that uncertainty.

In family medicine, I’ve learned that I must hold both the biomedical and the biopsychosocial models in parallel. While I search for an organic cause for a patient’s symptoms — seeking the “objective truth” of the biomedical model — I also need to stay present to the patient’s lived, subjective experience, and my own emotional response to it.

This is what it means to practice medicine in the real world: to live, and work, with uncertainty.