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Book Review: Seven Strategies for Helping Patients Understand Risks

  1. Prepare by first learning about the actual difficulties that patients experience in attempting to understand risks.
  2. Accept the challenge that patients' emotions will invariably filter the facts and cannot be ignored.
  3. Revise the way you explain probabilities to patients. The most commonly-used methods can be greatly improved with small changes.
  4. Try to avoid speaking to patients in terms of relative risks. Ensure you provide context so patients get “information” and not just “data”.
  5. Never give the negative perspective, but, instead, make sure the positive perspective is always provided as well.
  6. Explain the risk numbers by using visual aids. These give context as well as achieving understanding for the largest number of patients.
  7. Realise that sharing aids with patients can serve to reinforce the doctor-patient bond, enhance trust and encourage acceptance of the doctor's message.

These are the seven key messages from John Paling's book Helping Patients Understand Risks. (ISBN 0-9642236-0-0, available from; $30 + $8 postage). Paling makes the point that in industries where risks have to be communicated to the public (food, nuclear, water, chemical), there is awareness that communicating risk is difficult. There are therefore a few highly-trained people who speak for these industries.

In healthcare, where risks are much more numerous, and far more common, and certainly more complex, almost every professional communicates risk to patients, and almost none have any training at all in risk communication. Paling's book runs to 185 pages, is punctuated with pithy quotes and examples, and leads the reader though his seven steps. It is a training in risk communication.

Will it solve all the problems? Nope, because we just have not done enough work on risk communication with patients. We haven't worked up enough examples, we haven't generated different methods of explaining risks, or contexts in which to set them, or visual aids and words, and we certainly haven't tested them to know what works best in whom.

But it is time to wake up to the problem, and begin doing some serious work. Western societies, some of them anyway, have passed a tipping point. People now want to make the choices about treatment options, and those choices are different from those that might be made by doctors or healthcare providers, and especially health technology assessment. In patient-led healthcare, describing numbers to patients is the key. Buy Paling's book from the website and start the journey.

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