Decision Making Amidst Uncertainty

Scenario

Maya is a junior biology major volunteering at a free health clinic through her university’s community engagement summer program. The clinic is located in a low-income neighborhood, and struggles to keep up with the needs of the community, in addition to being understaffed. Maya has been mostly helping with patient intake. She records symptoms, checks vitals, and passes information to her supervisor Dr. Reyes, a physician who has worked at this clinic for over a decade. Maya admires Dr. Reyes, and her calm, efficient manner. She has an approach to challenges that only comes from long experience in a difficult working context.

Maya became interested in the medical field from experience with her family. Her younger brother has lived with Type 1 diabetes since he was nine. She has spent years at his side learning the condition in the way families do—not from textbooks, but from emergency room visits, late-night glucose checks, and hard lessons about what to watch for. But even with as much expertise as she’s gained around managing her brother’s condition, the experience has also taught her how much she doesn’t yet know, and just how complex the job of a physician can be.

Midway through one morning, Maya does intake for a woman named Gloria, who is presenting with fatigue. Gloria mentions, almost incidentally, that she has been very thirsty lately and stopped taking one of her medications because she couldn’t afford it. Something tightens in Maya’s chest. That combination reminds her, viscerally, of her brother before a serious episode. But she isn’t sure. Dr. Reyes has already seen Gloria briefly. Maybe she noticed. Maybe it’s nothing, or maybe it’s something that Maya doesn’t have the training to properly evaluate. She knows she still has so much to learn, but at the same time she has had a lot of experience with this condition, and this could be serious.

Maya turns the question over? Is what I’m sensing correct? Is it my place to say something? She is aware of the overflowing waiting room, the rhythm of the clinic, and of her own position as a volunteer. She knows that speaking up could embarrass her, and could disrupt the already strained workflow of the clinic. She thinks she’s right, but knows she could be wrong.

Finally, Maya decides to say something—not because she is certain, but because the cost of being wrong in one direction is so much greater than the costs of being wrong in the other. She heads out to find Dr. Reyes.

Discussion Questions

1. Maya feels the pull of two competing virtues: the courage to act by speaking up for a patient, and the humility to respect someone with far more experience. How could she balance these? Is there a way to honor both at once?
2. We don’t know whether Dr. Reyes actually missed something with Gloria. Does that uncertainty change how you evaluate Maya’s decision to speak up? Should it?
3. Maya’s knowledge comes from personal experience, not formal training. How much weight should that kind of knowledge carry in a professional setting — and how should you communicate it when you think it matters?
4. Practical Wisdom involves doing the right thing, at the right time, even when competing values are at stake.
   1. How do you see Maya utilizing practical wisdom in this scenario?
   2. Based on her evaluation of the situation, what do you think the right thing would be right now, even amidst the uncertainty? 
   3. What next steps do you think Maya should take? 
5. If Maya approaches Dr. Reyes and the interaction goes well, we might think that she made the right decision. But imagine that Maya was simply wrong, or that Dr. Reyes is offended or responds negatively to Maya. Would this change how you think about Maya’s decision?
6. If you were Maya, standing in that hallway afterward, what would you do next?

Facilitator Consideration

• UNPACK THE INTERNAL PROCESS. The heart of this case is not what Maya did, but how she decided to do it. Before evaluating her choice, ask students to reconstruct her reasoning: What did she notice? What did she weigh? What would it have meant to stay silent?
• LEAN INTO COMPLEXITY. This case involves very difficult questions around what it means to have knowledge and how to go about sharing that knowledge in a complex and challenging context. Discussing concrete strategies for handling a situation like this may be valuable or of interest, but if you want to focus on these prior questions, don’t allow them to transition into the concrete too quickly.
• DEVELOP PRACTICAL WISDOM. Explore questions of what it means to be confident in one’s own knowledge while also remaining humble. Consider what habits of mind, not just behaviors, but ways of perceiving and reasoning, would help someone like Maya develop better judgement over time.

Closing Questions

• What’s one thing you learned or thought about differently during this discussion?
• What specific contextual knowledge do you bring to your engagement work? What role should this play in being a good community partner, not just a knowledgeable one?