Communicating with Patients about Harms and Risks

E verything that doctors and other health workers do involves communication about the benefi ts and harms to be expected from interventions—whether they are therapeutic, diagnostic, or prophylactic. As health-care professionals, we need to share our understanding and perceptions of benefi ts and harms with patients and their families as fully as we can. We also have to share them with other professionals. When we do so we have to remember that how we personally value particular benefi ts and harms may well differ from how another person values them. A clinician who recommends an intervention does so in the belief that its benefi ts outweigh the harms that it can cause. In most consultations there is little time in which to explain in detail what these benefi ts and harms are, or to fi nd out what the patient thinks about them. Moreover, most clinicians are not trained or practised at describing and explaining benefi ts and harms clearly to patients, and much of the time they also lack important information about these aspects. " Risk " Versus " Harm " The problems begin with the word " risk ". Very often people use it when they mean " harm " , and this causes ambiguities and confusion. The widely used expression " benefi t/risk ratio " is meaningless—no such ratio exists. Before a decision is made to use an intervention, its benefi ts and harms must be weighed, ideally by the clinician and the patient together. Other advantages and disadvantages, such as convenience and cost, may also be relevant. This analysis requires use of the same dimensions for considering both benefi ts and harms. These dimensions have not been generally recognised or taught, though they seem obvious enough. In this context any benefi t or harm has four dimensions (see sidebar). The clinician is expected to know or fi nd out about the nature and probability of each benefi t and harm, and how to maximise benefi ts and minimise harms. A great many clinicians do not meet this expectation, and often that is not their fault. But only patients can say how they regard the hoped for benefi ts and the possible harms, though they may need help to think clearly about them. Clinicians should identify how much the benefi ts matter to their patient—for example, are the benefi ts of taking a medicine or having an …