Dear Marion,

A comment about communication - among ourselves or
between physician and patient. The Vienna Circle's
(Wiener Kreis - Moritz Schlick) concept of "protocol
sentence" is highly relevant. The date, the hour and the
minute, the price attached to a transaction, weight,
temperature are examples of "facts" (symbolic data)
which are unequivocal and which, barring misunderstanding
will receive identical interpretations from the parties
to the communication. Usually, however, ambiguity is 
difficult to avoid. E.g. the place name Harvard Square
may be interpreted as a pointer to Massachusetts Avenue,
or to Boylston Street, or to Brattle Street, - or to
none or to all of these. Surveyors take great pains to
identify exact locations. Many terms, for example diagnoses,
may have a specific definition but a penumbra of applications
so diffuse that in a given case the meaning must be determined
by induction from a spectrum of symptoms and signs.

It is a rare patient who is sufficiently intelligent and
sensitive to understand and to accept the uncertainties
and ambiguities of language. Much damage is done to patients
by physicians who consider themselves obliged and able to
tell their patients "The Truth." I frequently find myself
in the position of being required to give a patient a certain
item of "information"; but I have become quite proficient
in neutralizing the misunderstanding by explaining in what
sense I believe the required information to be misleading
or untrue. I frequently explain to patients about given
facts that I am ignorant of them and/or that they are 
inherently unknowable. The uncertainty principles of 
statistics that I recently mentioned seem to me relevant
to much medical "knowledge" that is peddled as being "true."

Jochen