Using the terms “low-risk” or “high-risk” are often difficult to interpret.
Recently, I highlighted the importance of being adequately informed before consenting to a medical procedure or intervention. You, the patient, should be at the centre of any decision-making process and it is your doctor’s duty to provide the facts rather than dictate treatment.
Very often, the main factor in deciding on an intervention such as surgery is determining the risk involved. And your understanding of that risk is heavily dependant on how it is presented and explained to you.
After all, what is risk? Risk can be thought of as the chance that anything could occur and cause you harm. Almost everything we do in our daily lives carry some degree of risk. Life itself is a risky business.
Most people will generally take a risk if they feel that there is a benefit or advantage. Ideally the benefit of an intervention or procedure should outweigh the risks. There is no such thing as zero risk, and how people in general perceive risk is very variable.
For instance, before surgery, you may be told that it is “high-risk” or “low risk”. Sometimes this is difficult to interpret and does require some form of explanation or quantification. The risks of the proposed surgery and the chance of complications should be presented in a way that is easily understood. This can often be separated into:
- Frequent risks
- Serious risks
- Unavoidable risks, and each should be discussed in detail.
In some cases, this may be better expressed by using a figure such as a frequency. For example, a verbal description of “very common” is usually equivalent to a risk of 1 in 1 or 1 in 10, while “rare” could mean 1 in 1,000 to 1 in 10,000 and “very rare” is less than 1 in 10,000.
Healthcare professionals should use robust research evidence to advise on these risks. Usually this is done in the context of an entire population and this may be challenging for several reasons. Your doctor may say to you that one in 9 women will be affected by breast cancer but cannot tell you if that “one” will be you.
Similarly, the risk of getting a wound infection after a hysterectomy is about 10 per cent, but that figure may reflect a generalised, population-based finding and may not at all reflect an individual surgeon’s or hospital’s figures which can vary due to subtle differences in practice.
Therefore, if patients are to be quoted accurate rates of specific complications, this should ideally come from the surgeon’s own figures or that of their department rather than the entire population. My rate of wound infection for the women who I operate on may indeed be different from another surgeon as a result of variations, such as use of antibiotics, rigorous cleanliness, handwashing practices etc.
Consequently, it is imperative for doctors to give their patients an accurate description of their own complication rates. This can only be done by auditing their own practice to detect deficiencies and make changes to improve them.
How risk is presented to us can also be misleading. The 1995 “pill scare” shows how risk was taken out of context and reported in a distorted and confusing way. At that time, it was reported that some birth control pills doubled the risk of a developing a blood clot (thromboembolism) when compared to other birth control pills.
This caused panic in the media as well as the public with many women stopping their pills. After all, saying that something “doubles” give the impression of a large amount. What the report initially failed to mention though was that the risks of a clot with the contraceptive pill were only 1 in 6,000 to begin with which is considered to be “rare”. The new reported risk was 1 in 3000 (or 2 in 6,000)—still “rare” with the increase being about one person in a million. This risk had not been put into context and therefore led to a fair amount of misunderstanding.
In the end, it is crucial to have the facts explained in a meaningful way, not just to enable you to consent in an informed way to a medical procedure, but to be fully aware of potential risks involved. Defining that level of risk in the best possible way allows you to have more realistic expectations and a greater understanding and agreement between you and your doctor.
