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July 28, 2009

Distortion of Risk Assessment for Surgical Complications

Image courtesy of Stuart Miles
at FreeDigitalPhotos.net
Over time and experience as well as being exposed to some pop psychology by the likes of Malcolm Gladwell, Nassim Taleb, Ori & Rom Brafman, Robert Krulwich, Jad Abumrad, among others, I have realized that patients assess surgical risk in very different ways with most using irrational considerations.

Too often, physicians use statistics, numbers, and facts to counsel patients on risk whether it be surgical or some other medical intervention (medications, CT scan, etc). And we should. However, how patients process this information is more often based on emotive factors and anecdotal stories heard from friends, family, as well as internet.

Such "stories" whether from friends or the internet is perhaps one of my biggest allies as well as bane of my existence. Why? Because patients make decisions based on the experiences of a few individuals. Facts? Statistics? They play only a minor role. To make things worse, such stories are expressed in more negative terms than positive.

Why is that?

I think it's because people who experience a bad outcome are FAR more vocal from a perceived sense of injustice than those who experience the good (and expected) outcome.

As the saying goes, a person with a good outcome tells 1 or their friends whereas a person who has a bad experience tells 5 friends.

It is against just this kind of backdrop that patients "listen" to the statistics, but are influenced by the stories they hear.


To make things worse, risk evaluation is distorted by the lack of control patients feel. It is why there are so many people who are afraid of flying and yet have no trouble driving a car where the risk of death is MUCH higher. Or why most people are horrified by the idea of a gun in the house but won't blink twice about a swimming pool which kills far more kids than guns.

How is a physician to combat such forces in order to allow for a more reasoned decision made by the patient for a given medical intervention?

I have no solution to this problem other than to keep aware of what patients are hearing and being mindful of such emotive factors when providing counselling. In practical terms what does this mean? It means I read... a lot... and not just from medical journals either, but newspapers, magazines, blogs, and other sources that patients probably encounter before seeing a physician. Thank goodness for online news collators (Medical News Today, Topix.net, etc) as well as Twitter.

I also produce my own online literature to balance out (hopefully) the other materials that are out there, but more so in story format in layperson terms rather than factual & medical regurgitation and use of ambiguous language (where emphasis is "see your doctor" for more specific information) that plague more reputable medical websites.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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