How to tactfully communicate risks to patients so that they understand: Dr. YK Amdekar

M3 India Newsdesk Nov 08, 2019

Dr. YK Amdekar provides doctor-patient communication pointers on tactfully sharing information about possible treatment risks and side effects to patients and families/relatives, while keeping their hope and confidence alive of a positive outcome.


Risk is involved in every step of life. It is always right to take a risk when benefit clearly outweighs it. Even in such a favourable situation, there exists a risk that should be downplayed. A doctor has to be tactful to communicate when risk is high but must be taken for hopeful outcome as against not taking a risk which is a sure disaster. It should be communicated in such a way that a patient is encouraged to feel that he is bound to improve. Your experience about stories of success in similar situations helps to boost the morale of the patient. It has a positive impact that improves chance of success.


Concept of “risk”

Risk refers to a chance of unacceptable outcome of any action. Life itself is a series of taking risks as every step has a margin of risk, however small it may be. No outcome is 100% certain and so there is always a fear of uncertainty. In fact, medicine is a science of uncertainty and doctors have to depend on art of probability. Therefore it always involves some risk. Moreover, outcome of medical treatment depends on many variables, of which, the most unpredictable variable is an individual patient’s response to treatment.

The doctor has no control over a patient’s response as much as a teacher has no control over a student’s response, and therefore outcome is not in the hands of a doctor. Even the best of the treatment may not guarantee best outcome.


How to practice risk management

It is a process of identifying, monitoring, and managing a potential risk situation in order to minimise negative impact. As every act has a potential risk, a doctor must evaluate risk-benefit ratio. One has to weigh the pros and cons.

First consider what may happen naturally if no action is taken. After all no action may be apparently safer than any action as in case of minor trauma that heals by itself or a viral infection that is self-limiting. However, in a curable bacterial infection, antibiotic should not be withheld just because there is a possibility of side effects of an antibiotic. In such a situation, side effects of the antibiotic are so minor as compared to benefit of cure of bacterial infection which may otherwise endanger life. So clearly benefit outweighs risk and so such a risk is worth taking.

In such situation, it is best not to talk upfront about side effects. When asked by the patient, one should highlight safety of the drug with rarely minimum and inconsequential temporary side effects. Many patients are well informed through “google-doctor” and have read more about side effects than effects, so let patients know that you are responsible for correct information and 'googled' information is not necessarily applicable to everyone.

To a very inquisitive patient who talks only about side effects, I often given them an example that makes them understand a point. I ask them whether it is safe to sit in my clinic under a roof that may collapse anytime. Well, there is always a possibility of collapse to a pessimist but optimist never thinks about it and he is mostly right.

Every day one hears about fatal accidents on road and even then no one stops travelling, simply because risk is negligible. However, a situation wherein, chance of risk and benefit are equal, the decision is difficult and should be taken together with the patient. For example, treatment of cancer may be equally dangerous to life as cancer is. Besides, side effects of treatment may be unbearable requiring repeated hospitalisation as against natural sinking that may be less painful.

It is an individual patient’s mindset that should decide best possible action. But there is always a hope for improvement and so many may be ready to take a risk. Calculated risk is a need to achieve a goal.


Use communication skills

Communication refers to giving relevant information to the patient.

  1. Relevance must be appropriate to the situation.
  2. Information should not only be truthful but at the same time, should not discourage the patient to lose hope of improvement.
  3. One needs to be tactful. Most important is the fact that patient should not feel that the doctor is hiding some information. Such a suspicion leads to despair. So best is to explain to relatives in front of the patient.
  4. Always emphasise on positives first. Even in a dire situation that holds significant risk- once you decide that the risk is worth taking, talk to the patient about the negative impact of not taking a risk. It may amount to a definite disaster, while taking a risk may have equal chances of success.
  5. It is a good idea to describe your own experience about similar patients who have done well. At times, such stories could be fictitious but bring hope.
  6. Mind plays a significant role in recovery. Doctor must imbibe confidence in a patient that success is most likely and so risk is worth taking.
  7. Finally, universal faith on almighty is embedded in our culture, especially in high-risk situations. So it is appropriate to convince a patient that you will leave nothing undone and put up best efforts. After all outcome depends on luck and luck favours the brave. So, the patient must pray and keep cool while you as a doctor do your best.

 

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

 

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