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.

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.

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.