Why is ignorance so important to clinical practice?

One of the best presentations I saw at the recent In Sickness and In Health conference (link to conference programme here), was by Trudy Rudge and Amelie Perron titled 'In praise of ignorance? Towards an epistemology of “unknowing” in nursing and health care.'

Rudge and Perron are both brilliant critical nursing researchers, and they were previewing some of the ideas in their upcoming book (link).

Their argument was in part that although we might like the idea of certainty in our practice, certainty is not always available.  More than this, certainty and risk have become hallmarks of good practice, when in fact, our ability to embrace uncertainty is a much more significant feature of mature clinical practice.

So much time is spent in western science trying to eliminate uncertainty and ambiguity through logic and reason that it is easy to see complexity as simply a set of variables to be manipulated and managed.  While this might work as a way of understanding human beings biologically, it doesn't work so well in the real world.

Rudge and Perron's project, then, is an exploration of the epistemology (how we know what we know) of ignorance, that challenges the ways in which we simplify, quantify and standardise care.

Their focus is on the messiness of practice and embracing ignorance as a productive and creative urge that governs most of our desire to know more, question what we do, and grow.

Rudge and Perron promoted the idea of productive ignorance, giving a positive face to an idea that is often portrayed by science as something to be eliminated.  Their argument was that ignorance is not something that should be left for science to resolve, but needs to be explored with approaches that embrace uncertainty, ambiguity and unpredictability.

In many ways this idea mirrors the idea of silence in teaching and learning that I had written about in an earlier post (link).  Silence and ignorance are important concepts in critical theory, because they reject a lot of the traditionally scientific ways we've come to view the world and they emphasise the indeterminacy of real practice.

Silence and ignorance are significant concepts in teaching, learning and practice because they both refer to the space between where one's thoughts and actions might be right now, and where the might need to be in the future.  For instance, I might have a patient who has problems I've never encountered before.  The traditional approach to these problems might be to try to fill the void with knowledge that may be offered as 'facts.' The effect of this is that it closes down the inherent ambiguity of the patient's situation and removes the desire to explore further research and learn that is made possible by recognising one's ignorance.  By contrast, embracing the void that exists between what you currently know and what you might need keeps alive the possibility of more learning, more growth and more critical inquiry.

While this approach is critical of the dogma of science in health care, it also recognises that science can provide some of the ways to navigate across the void.  It goes beyond this though, to argue that sometimes ignorance and silence are better.