We are confusing certainty with safety; and neuroscience says that’s a big mistake.

As someone with a low tolerance for uncertainty, I spent much of my career trying to eliminate it, at significant personal cost:

Overworking, distracting myself by keeping busy. Equating uncertainty with threat.

I now realise I was not only training my own nervous system into burnout but also misunderstanding a critical difference between threat and uncertainty.

And I am not alone.

Modern healthcare is obsessed with a toxic pursuit of certainty:

Protocols.
Pathways.
Checklists.
Algorithms.
“Right answers.”

But reading Maggie Jackson’s latest book, Uncertain: The Wisdom and Wonder of Being Unsure forced me to completely rethink how uncertainty works in the brain.

Our brains are not designed to operate optimally in rigid, engineered certainty, which works largely through basal ganglia habit loops.

They are designed to work through and explore uncertainty.

When clinicians work in less prescribed, more psychologically safe environments, then uncertainty doesn’t trigger our threat system. Instead, it activates the prefrontal cortex, the brain area responsible for:

• professional judgement
• balancing treatment risk
• contextual decision-making
• innovation
• empathy

This is the neurological basis of our clinical wisdom.

Uncertainty also activates the curiosity circuit (anterior cingulate, nucleus accumbens, ventral tegmental area).

Crucially, dopamine spikes in these areas not only through anticipated reward, but also through information gaps, those moments of not-knowing, strengthening learning, memory and insight formation.

And so here is the distinction I failed to make for years:

Uncertainty is not the same as threat.

Toxic uncertainty is perceived as threat, activating the amygdala, high stress, high cortisol, narrowed attention, defensive behaviour, burnout.

But structured, safe, generative uncertainty does the opposite.
It increases neuroplasticity, curiosity, judgement quality and the depth of our learning.
And it’s the engine of creativity, wisdom and innovation.

The distinction between the two matters.

If uncertainty is not protected by:

• psychological safety
• adequate staffing
• time to think
• permission to question
• supportive governance

then it does not strengthen judgement, rather, it tips us into threat.

We risk replacing generative uncertainty with artificially engineered, protocolised certainty, and professional judgement with compliance.

The result is not safer medicine.

Instead, it is more brittle, more formulaic, more unthinking medicine.

If we want to improve care, protect our own wellbeing and preserve clinical wisdom, we need to stop asking:

“How do we remove uncertainty?”

and start asking:

“Which uncertainty must we protect, and how do we stop it morphing into threat?”

Because when we learn to sit with uncertainty, both individually and collectively, stay curious and avoid it tipping into threat, our wellbeing improves, our judgement deepens, and our capacity for empathy and innovation flourishes.

Everyone wins

Thanks to Minnie Molyneux for highlighting the work of Maggie Johnson