Taking risks seriously.

I was working recently with a group of Danish doctors on a course where they had a chance to talk about some of their most difficult patients: complex cases, challenging ones, people who had worn them down over the years by consulting very often but never getting any better. One theme came up again and again in their stories. It was the theme of risk. The doctors on the course didn’t mean the kind of risk we spend so much time thinking about in medicine these days, like blood pressure, smoking or obesity. What they had in mind was the way doctors sometimes to take emotional risks with patientsdfor example, by cracking a joke, being intentionally provocative, and even losing their temper. Time and again, they told stories of how they had turned the corner with difficult patients not by being boringly predictable or scientifically clever, but by showing their own emotions. The stories they told weren’t about being punitive or moralistic. They were all about being authentic, being themselves. Listening to them, I was struck by a certain paradox. I began to wonder if we have become preoccupied in medicine with preventing health risks in patients, while forgetting the art of the taking emotional risks ourselves. To some extent this may simply be due to technology: we often spend more time nowadays looking at screens and writing requests for blood tests than we do talking with patients. But I suspect it may be part of a change in our attitudes too. We are more scared than we used to be of lawyers, managers, commissioners and regulators, and so we have become emotionally risk averse. In the UK, I fear that the kind of courageous medicine my Danish colleagues were describing is becoming a thing of the past.