The Key Factors When Explaining Treatment Risk

Shelly Reese

Disclosures

February 04, 2015

In This Article

Conveying the Dangers and the Benefits

Informed consent is a vital element in a patient's treatment, but it's also a part that can land physicians in legal trouble. While many doctors feel that they do a good job of explaining treatment risks and benefits, that assessment may be more subjective than they realize.

Describing risks, which are myriad and varied, can be more complicated than physicians realize, particularly in light of the time constraints of an office visit and the emotionally charged nature of the conversation.

Nearly 3 out of 10 of the 21,000 physicians surveyed as part of Medscape's 2014 Ethics Survey say they would (13%) or might (16%) "be less aggressive about describing risks" if they believed a procedure or treatment would help the patient. Physicians' comments included such remarks as, "If the benefits outweighed the risks, I might do this to encourage the family to choose the treatment"; "I would fully disclose the risks, but I would also emphasize the benefits"; and "most patients want to hear a clear directive to help resolve their problem and not the either/or, pro/con debate."

While such thinking may be well intentioned, experts say it's ill advised. Full disclosure of risks is essential to ensuring patient autonomy, experts say, and a potential legal minefield. When it comes to discussing risks, there can't be any shortcuts.

Watch How You Say It

"When it comes to describing risk, what the physician says is critical, but how they say it is equally important," says Monica Broome, MD, an internist and director of the Communication Skills Program at the University of Miami's Miller School of Medicine.

Research conducted in the 1970s by Albert Mehrabian[1] found that spoken words account for only about 7% of communication, she says, noting that the bulk of communication is composed of nonverbal cues (55%) and tone of voice (38%). Patients are very attuned to physicians' tones. A study published in the July 2002 issue of the journal Surgery[2] found a clear correlation between surgeons' tone of voice during routine visits and their malpractice claims history. Surgeons whose tones conveyed dominance were more likely to have been sued than those whose tones conveyed warmth and empathy.

When having an informed consent discussion, a doctor needs to look the patient in the eye rather than analyzing a body part or staring at a computer and respond empathically to patients' reactions, Dr Broome advises. Simple phrases such as, "I know this is scary," or "I understand your concern," can help physicians better connect with their patients.

Medical conversations can be intense, and "there is a lot of evidence that when physicians don't acknowledge the emotional component of what they're saying, patients leave feeling unsettled. Just acknowledging that emotional component helps people leave feeling respected and understood," she says.

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