Early-career genetic counselors (GCs) may encounter a breadth of formative themes as they transition into clinical practice — themes they may absorb and that even gradually influence their worldview. One that often becomes apparent early in clinical genetics is the simple idea that, perhaps, we know nothing. This sentiment may seem paradoxical as many patients arrive to the practice of clinical genetics expecting finite answers — which some patients do receive. However, as this is only occasionally the outcome, early-career GCs are often challenged to develop strong communication skills in order to effectively assist others in navigating nuance and uncertainty. 

At first, uncertainty in clinical genetics seems like something that is characterizable; the variant of uncertain significance. “We do not have enough information currently to know if this variant is disease-causing” becomes an everyday phrase. However, uncertainty is an accomplice to positive results as well — “this finding can explain some of your symptoms, but we are unsure if it would explain the breadth of your clinical history.” Likewise, a negative result may not necessarily yield absolution for a patient: “There may be a genetic change present that we have yet to find.” As statements like these become canon, they lay the foundation for a theoretical world of “what-ifs,” which GCs learn to carefully navigate in tandem with reality. However, cautiously wavering in and out of this world of “what-ifs” may heighten awareness of uncertainty and incite a breadth of emotions such as worry and unease. These emotions, in turn, may give rise to a sense of nihilism — which can be described as an extreme form of skepticism or denial of the possibility of an objective basis for truth, leading to a sense of obscurity. 

As an early-career genetic counselor, I found it difficult to maintain balance between what is finite and what is uncertain. While the counseling itself was challenging, absorbing patients’ frustrations with uncertainty had the potential to likewise weigh heavily. The emotional countertransference of these clinical encounters led me to question the level of certainty in my own life and, nihilistically, this questioning led me to consider if “truth” was an attainable concept in any form.

Over the past five years, my work as a clinical GC has made it easier for me to exist side-by-side with uncertainty — recognizing that it can be omnipresent without interrupting my worldview. While such recognition can be seen as a product of sensitization over the years, I do not think this is the case. Rather, I think my observations and experiences challenged me to release rigid beliefs I once held on certainty and truth. I found that acknowledgement, and even acceptance, of the limitations of my own understanding can foster a unique curiosity that is dynamic rather than laden in a sense of emptiness and angst. 

The value of community has also proven important here. Sharing my observations with, and hearing the stories of, colleagues, mentors and friends helped me feel peaceful and grounded by acknowledging collective professional experiences. Further, I found that seeing the resilience and poise of my patients navigating uncertainties encouraged me to cultivate the same qualities within myself. I hope my reflections here provide both optimism and solidarity to GCs who may encounter these thoughts during their work, or simply while ruminating on the meaning of an uncertain world. 

Reference

Collins Dictionary. Nihilism. In Collins English Dictionary. Retrieved September 17, 2025, from https://www.collinsdictionary.com/us/dictionary/english/nihilism

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