Communicating Risks: Let's Talk Numeracy

Fam Pract Manag. 2018 Nov-Dec;25(6):4.

In the last issue of FPM, I proclaimed how family physicians are great communicators. (See “Physician-Patient Communication: A Family Medicine Strength,” FPM, September/October 2018.) But I added that there is always room for improvement. An article in this issue, “Five Ways to Communicate Risks So That Patients Understand,” by Sarina Schrager, MD, underscores that there is definitely room to improve.

Good communication combines both excellent delivery and receipt of a message. When it comes to communicating the concept of risk, failures can occur at both ends. Risk is an inherently mathematical concept involving percentages, fractions, or simple frequencies. To understand risk, individuals need to have good numeracy skills – the ability to understand and work with numbers. Unfortunately, many of our patients don't have such skills.

Schrager outlines five strategies for presenting risks to patients so that they will understand: 1) remind the patient that all options confer some risk, 2) use absolute risk rather than relative risk to reduce bias, 3) be careful about the way you present numbers (read the article to find out how to do this right), 4) use visual aids, and 5) use plain language.

It turns out that we as physicians have some bad habits. We tend to overestimate the risk of a condition and underestimate the risk of treatment.1 Additionally, we often present differences in risk as relative risk rather than absolute risk. This can be misleading. For example, if X cuts your risk of Y by 50 percent, that sounds compelling. But it could mean reducing your risk of Y from, say, 40 percent to 20 percent, or it could mean reducing your risk of Y from 2 percent to 1 percent. I don't know about you, but I'd be much less likely to take on the risk of a treatment to receive an absolute risk reduction of 1 percent as opposed to an absolute risk reduction of 20 percent.

Communicating risks in a clear and effective fashion is a fundamental component of both informed consent and shared decision making. Understanding numeracy principles adds yet another arrow to your communication quiver.

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