Mindset
“Maturity, one discovers, has everything to do with the acceptance of ‘not knowing’.”
-Mark Z. Danielewski
I had a conversation this past week with my old friend Gerry Ramogida for the Leave Your Mark podcast. Gerry and I have known each other for a long time, and between the two of us, we have spent the better part of sixty years working with human beings trying to help them heal, move, perform, and sometimes simply find their way back to doing something that matters to them.
You would think that after all that time we might have figured some things out.
And I suppose we have.
But somewhere during our conversation, Gerry said something that stayed with me. After nearly thirty years of doing this work, he said, the only thing he has really learned is that certainty does not exist. The only certainty is uncertainty.
I laughed when he said it because I knew exactly what he meant.
There is an interesting paradox that comes with experience. When you are young and beginning a career, you don’t know very much, but you desperately want to know. You search for answers. You take courses. You read books and papers. You listen to people who seem to know more than you do. You learn systems and methodologies and techniques, and each new piece of knowledge feels like another piece of the puzzle clicking into place.
There is comfort in that.
If this happens, do that. If you see this presentation, use this intervention. If this tissue is injured, follow this protocol. If this movement looks like that, correct it this way.
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Certainty feels a lot like competence when you’re starting.
The problem is that human beings eventually ruin the simplicity of all those rules.
You encounter the person who should respond to the intervention but doesn’t. The athlete whose imaging looks terrible but performs beautifully. The person whose imaging looks perfectly acceptable but can’t function without pain. You meet two people with seemingly identical diagnoses who respond completely differently to the same treatment. You follow the evidence, apply the protocol, check all the boxes, and still something doesn’t make sense.
If you stay curious long enough, those experiences begin to change you.
You slowly discover that expertise may not be the accumulation of certainty we imagined it would be. In fact, it may be almost the opposite.
Experience gives us more information from which to make decisions, but it also exposes us to enough exceptions that we become increasingly reluctant to believe there is only one explanation for what we see.
That doesn’t mean knowledge becomes less important. Quite the contrary. Gerry made this point beautifully in our conversation. If you don’t understand anatomy, biomechanics, physiology, the demands of the activity, and what the person in front of you is actually trying to accomplish, you don’t have a meaningful starting point. We need foundations. We need knowledge. We need enough understanding to develop an intelligent hypothesis.
But a hypothesis is not an answer.
It is an invitation to explore.
That distinction has become increasingly important to me.
When someone comes to us with a problem, there is an enormous temptation to identify the thing that is wrong. We have built much of healthcare around this idea. Diagnose the pathology, identify the impaired structure, name the dysfunction, and then apply the appropriate solution.
There is obvious value in diagnosis. There are things we absolutely need to know.
But the danger comes when the diagnosis becomes the person.
During our conversation, Gerry talked about how easily we can become so focused on the small percentage of the individual represented by the pathology that we forget about everything else. Sometimes when we begin working with the rest of the human being, improving capacities, changing movement options, altering inputs, exposing them to different environments and giving the system new ways to solve the problem, the thing we were so worried about becomes considerably less important.
Not because it disappeared.
Because its significance changed.
This is where uncertainty becomes uncomfortable, because it asks something different of the practitioner. Instead of simply knowing what to do, we have to become good at paying attention.
We observe.
We develop a hypothesis.
We intervene.
Then we look again.
Did something change?
If it did, what changed? If it didn’t, what else might be contributing? Where else should we look? What assumption are we holding onto simply because it is familiar to us?
Gerry described a phrase he has heard repeatedly from another experienced practitioner: “What else? Where else?”
I love that.
There is humility embedded in those questions.
They don’t mean we know nothing. They mean we recognize that what we know may not yet be enough to explain what is happening in front of us.
That is a very different relationship with expertise.
I think when I was younger I believed the best practitioners had the most answers. After nearly forty years in this profession, I am increasingly convinced that the best practitioners may simply have better questions.
They notice more.
They listen longer.
They understand context.
They recognize patterns without becoming imprisoned by them. They are willing to act on their experience while remaining prepared to change direction when the person in front of them tells them, through their response, that their original idea was wrong.
There is a confidence in that, but it isn’t the confidence of certainty.
It is the confidence of adaptability.
Maybe that is one of the great transitions of a career. Early on, we build confidence by accumulating tools. Later, if we’re paying attention, we begin to build confidence in our ability to navigate without knowing exactly where the road will take us.
I find myself increasingly comfortable living there.
It doesn’t mean I don’t have opinions. I have plenty of them. It doesn’t mean I don’t make decisions or that four decades of experience haven’t given me instincts I trust. They have. Experience matters enormously.
But I have become less attached to needing my first idea to be right.
If I apply an input and nothing changes, that is information.
If someone responds in a way I didn’t expect, that is information.
If the intervention that worked beautifully yesterday does nothing today, that is information too.
The goal isn’t to defend the methodology. The goal is to understand the person.
Maybe that is why uncertainty becomes easier to tolerate with experience. You eventually realize that uncertainty isn’t evidence that you don’t know what you’re doing. It is simply the environment in which this work has always existed.
Human beings are complex. They adapt. They compensate. They learn. They protect themselves. They respond to previous experiences, current environments, expectations, fears, capacities, relationships, and countless other variables we may never completely understand.
We aren’t going to solve that complexity by pretending it isn’t there.
Perhaps our responsibility is something different.
To know as much as we can.
To pay attention to what is actually happening.
To make the best decision available to us with the information we have.
To observe what happens next.
And to remain humble enough to change our minds.
Maybe wisdom isn’t finally arriving at certainty.
Maybe wisdom is becoming comfortable enough with uncertainty that we can keep exploring anyway.
