In my experience patients are quite willing to throw dice with me.
When explained properly many patients can cope with small and large
risks on diseases. It does make a difference, however, if it is
about cancer diagnostics, missing a myocardial infarction, or wait
and see in cases of a painful throat with fever and glands lasting
only a day.
If explained in terms of chances or rather percentages (in my country
odds are not a common sense outcome measure) patients are willing to
gamble, and wait and see. Just one precaution: always make sure to
control for course over time with an conditional agreement (if
this..., than I will see you next week...) or an unconditional
appointment (whatever the course, you phone me tomorrow to tell me
how you are doing).
I tried to explain chances to patients in terms of NNT: didn;t work.
I tried it with absolute risk reductions, or better, absolute risk
increase in ratio's (your chances are 1:100.000 to get a serious
pulmonary thromboembolia by taking this contraceptive drug - just a
wild guess - Your chances will double or triple, but still are very
small. 2 or 3 per 100.000. Two or three times very small still is a
small chance. Don't bother, take this drug. This appears to be quite
understandable.
Nico van Duijn, GP
Academic Medical Centre
University of Amsterdam
> Date: Sun, 23 May 1999 13:08:15 +0200
> Importance: Normal
> Subject: NNT's
> From: "Klazien Matter-Walstra" <[log in to unmask]>
> To: "EBH Discusision list" <[log in to unmask]>
> Reply-to: "Klazien Matter-Walstra" <[log in to unmask]>
> There is of cource a big diffenerence in perceiving NNT's or ARR. When you
> tell a patient 10 people have to be treated to get 1 positive result,
> everybody will hope to be this one patient which will have the advantage of
> the treatment or screening. Even if the NNT is very high, still the patient
> hopes he/she will be the one who is going to be better. On the other hand if
> you tell a patient he will have a 11% chance of a positive result he or she
> will think of him/her self of having this 11% chance and may decide it's not
> worse doing ( although people are willing to take a very small chance ) The
> thing is that as a patient you do not care about those 10 or 100 others who
> may be the loosers, you only think about yourself and the chance of being
> the winner. For the single patient it is " me or not me" and that's always a
> chance of 50%.
> So should we not more try to understand what these NNT's and ARR's mean to
> our patient ? Even the hope of being that one out of 1000 may give you the
> impuls to get better (?!). EBM discussions are still so "evidence" and
> "physician" orientated in stead of asking what is means to the patient. As
> long as we don't wonder and understand what all these discussions mean to
> the patient we won't get any further. The single patient doesn't see her/him
> self as 1 in a group of 100, It's only he/she who matters.
>
> With best regards,
> Dr. Klazien Matter-Walstra
>
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