> 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.
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> 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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