Forecast: Uncertain - Editorial - MSKMag Issue 35

This is a free preview of a paid episode. To hear more, visit mskmag.substack.com In recent years I have become obsessed with the Northern Lights. This is good timing actually, because we have been in a peak of the approximately decade-long cycle of solar activity, meaning space weather is, for a time, madder than usual. In 2024, that led to a series of events whereby we paid for flights and trains to the Arctic Circle for the September, only to see the aurora in my actual back garden in the May. You might have seen that there was an explosion of solar activity again this mid-October - you might, as I did again, have even seen the resulting Northern Lights in your back garden. I have seen a lot of silly things in my west end of Newcastle suburb but a green haze across the street, strong enough to beat city light pollution, might just top the lot. As a planner, the best and worst thing about the Northern Lights is their uncertainty. You have to be prepared: for the weather on earth, for the weather in space, with your photography equipment, to find dark skies…and crucially (as anyone who has forked out an arm and a leg for a trip to Scandinavia will attest to), for disappointment. Sometimes you find yourself in the right place - with dark skies, a stable camera and even a professional photographer - but the solar activity fizzles out into nothing. Sometimes your aurora alert app is dinging non-stop…but you can’t see anything for blankets of cloud. And sometimes, the activity of the literal star aligns, your night vision is not ruined by your security light, and you get to see the show. You will have, I’m sure, felt the same way sometimes in clinical practice: we can prepare all we like, but we can’t control the conditions. The road to recovery for both patients and clinicians alike is riddled with uncertainty. We are constantly adapting to ground shifts, atmospheric changes, and forecasts that read ‘uncertain’ - but that we still need to form a plan for. Oh, and can you do all this on your feet within 30 minutes? The challenge is summed up brilliantly by our staff writer **Giles Hazan**’s article this month: ‘The Art of Managing Uncertainty in Clinical Practice’ where he puts the problem into words and then shares ideas of how we can best embrace and respond to uncertainty without trying to chuck it away like a hot Chicken McNugget, which cameos in the piece. Is there anything more uncertain than perimenopause? Are my symptoms caused by it? Who knows!! Certainly not my own poor GP… BUT fortunately we do have experts like **Claire Callaghan** writing on ‘Perimenopause and MSK Health’; essential reading for anyone treating women from their 30s and beyond. If there’s one thing **Helena Bridge**’s headache patients are certain of, it’s that they’ve got a brain tumour - but what tools do we have in our kit to rule out the serious pathology and help improve the lives of those living with headache? Helena’s article ‘Headache patients: dream or nightmare?’ is packed full of practical tips. When, as **Jenni Dowley** writes, vertebral fractures are among the most common fragility fractures caused by osteoporosis, but also the least likely to be diagnosed, it’s safe to say we need to reduce our uncertainty in diagnosing them and ensuring people receive the right follow up care for their bone health. She helps us do just that in ‘Osteoporotic Vertebral Fractures: are we doing enough?’ And finally, **Michael Schumacher** is certain that ‘Everyone thinks AI can do everything. Except what they do’ in a blunt and important analysis of how MSK roles might be threatened by AI and what we can do about it now. The future might be uncertain but we’re not helpless. We can’t control the space weather, but we can make sure we’re standing in the right place and armed with the right kit when the lights come on.