I appreciate Dr. Poses's voicing concerns about the tensions between knowledge and uncertainty in medical practice. He argues, in effect, that the benefits of realizing the limits of certainty in our science are not worth the risks of upending positivism. I disagree. Perhaps our disagreements—which have been enacted elsewhere—are differences in framing. When I call sickness and doctoring narrative acts, I include within my frame not only the physical, pathophysiologic, and "trackable" events in a body and the pharmacologic and surgical interventions performed in response, but all the personal, emotional, relational, and ontological sequelae of failing health. Such dimensions of the experiences of patients and of doctors cannot be grasped without rigorous skills in apperceiving singular events in the lives of self and other, skills that proceed not from logico-scientific training but from narrative training. What most impresses me about this correspondence is the anxiety revealed in its lines, an anxiety I share, about the limits of certainty and reliability in perception and interpretation. As doctors and scientists, we must recognize humbly both the powers and the failings of our many means of understanding the world. Indeed, narrative methods incur certain risks born of engagement, while positivist methods incur the risks of detachment. No one would argue that much of what we think we know is eternal—we are not, after all, treating diseases of air, water, fire, and earth, and those in the future will not understand why we thought the heart was an organ. The dangers of any forms of knowing are lack of skepticism, rigidity, and hubris, for all these lead one to stop questioning what one accepts as true.

Rather than fuss about postmodernism (do notice that my tradition is narratology, which includes poststructuralist, structuralist, and prestructuralist thought), perhaps we can all accept very seriously the task of evaluating rigorously what we know and what we have yet to learn. I believe that we can most effectively do that through a balanced use of and respect for the range of quantitative and qualitative forms of knowledge available to us today. I am extremely grateful to Dr. Poses for his continuing efforts to invigorate our collective discourse about the epistemologies of medicine. He and I may, provisionally anyway, provide different answers, but we are addressing the same questions.