This issue of risk, uncertainty and clinician/patient exchange has been
explored in considerable depth in recent social science research
conducted as part of the ESRC/MRC research programme on Innovative
Health Technologies. Two projects in particular in the field of
screening and diagnostics related to Haemochromatosis and breast cancer
respectively reveal quite complex but also counter-intuitive patient
responses to risk calculations and susceptibility to genetically-related
disorders. See the 2nd Annual report via the Events page of the IHT 2003
Conference where there is a link page to a report on the projects by
Prior and Atkinson can be found, summarised in Prior's PowerPoint
presentation covering both projects . Go to:
http://www.york.ac.uk/res/iht/
Professor Andrew Webster
Director IHT Programme
University of York
UK
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Ghosh, Amit
K., M.D.
Sent: 20 January 2004 19:09
To: [log in to unmask]
Subject: Re: sad
> When explaining risk to patients, clinicians are typically focused on
> providing the facts about the risk (objective information), while
> patients typically are more interested in knowing how a bad outcome
> might affect them (subjective information). Patients, of course, also
> want to know the identity of the risk (death, disability, pain), its
> timing (early versus late), and the nature of the bad event
> (temporary, permanent), [JAMA 1999;281:1037-41.] When faced with a
> situation of conflicting evidence by several national guidelines, the
> practitioner is faced with a solitary dilemna. What do you do in the
> face of uncertainty and how do you explain probability. We have
> recently shown [Do medical students and physicians understand
> probability? Quart J Med 2004;97:53-55. ] that physician might be
> have difficulty with probability and using natural frequancy format
> might be a better and simpler form of explaining risks. From the
> patients stand point the anger comes , from the realisation that, "
> was in the physicans' office and all the did was talk! They involved
> me in a whole array of words, numbers, and NNT("again physicians and
> patients donot understand this consistently). Both the physicians and
> patient stand to lose sometimes. The patient from lack of
> understanding and the physician from lack of support from their own
> colleagues and from others in the event something bad happens.Worse
> still is the possibility of a bad event happening in the presence of a
> normal test( false negative). It risky business of talking about risk
> is that in an individual case things could go wrong, however being
> totally risk averse and panicky at these instances leading to a
> fatalistic approach to medicine and not being evidence-based would be
> to grave a danger. The only way not to have any of these problems is ,
> ' not to practice medicine, or be a 100% researcher without any
> patient contact!'. It is a sad thing which happened here, but we would
> be equally in the dark if we were to teach our students that medicine
> is not fraught with uncertainty. Not surprisingly internist and family
> practitioners( Martha Gerrity's work) handling uncertainty better
> than sub-specialists, though this very quality might land them into
> similar troubles.
>
> Amit K. Ghosh, MD, FACP
> Associate Program Director, General Internal Medicine Research
> Fellowship Assistant Professor of Medicine Mayo Clinic College of
> Medicine 200 1st Street, SW
> Rochester, MN, 55905
> Phone: 507-538-1128
> Fax: 507-284-4959
> [log in to unmask]
>
>
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