Interpreting Health Benefits and Risks: A Practical Guide to Facilitate Doctor-Patient Communication

Book Title: Interpreting Health Benefits and Risks: A Practical Guide to Facilitate Doctor-Patient Communication

Authors: Erik Rifkin and Andrew Lazris

Publication Information: Cham, Switzerland: Springer International Publishing, 2015, 231 pp., $69.93, paperback

How effective is your communication with your patients? This is a “no nonsense” read cowritten by an environmental scientist (Eric Rifkin, PhD)^1-3 with extensive experience in characterizing human health and ecological risks from exposure to contaminants, and a practicing internist with expertise in geriatrics (Andrew Lazris, MD).⁴ The book has a central theme of shared decision-making between the patient and the physician. The table of contents outlines key points—shared decision-making, decision aids, thoughts on universal decision aids, and discussion of how to involve patients in decision-making. Both authors feel strongly that decision aids such as visual graphics can better present a clear and objective picture of health benefits and risks associated with different medical interventions. They showcase a theater-style seating chart entitled Benefit/Risk Characterization Theater (BRCT), which can be used to facilitate the discussion between physician and patient about screenings and interventions. This visual aid depicts a typical theater of 1,000 seats, and marks in black the numbers of seats (representing individuals) affected by not undergoing a test (ie, mammogram) or initiating a treatment. The numbers are calculated as absolute risks and the focus is on outcomes.

The authors recommend that health risks and benefits be presented to patients as absolute risks. They define absolute risks and benefits as reflections of the number of individuals who will get a disease compared to the number of individuals being considered. The authors stress the importance of individual acceptable risk.

When counseling patients regarding the utility of screening tests and interventions, the authors recommend the following questions:

1. What are we looking for? What is the purpose?
2. Is the patient amenable to the suggested treatment and willing to accept side effects?
3. What are the consequences of not performing the test?
4. What are the risks of performing the test?

The remainder of the book is divided into a series of case studies, presenting brief discussions of common screening tests (colonoscopy, mammogram, prostate cancer screening), general screening (carotid disease, cholesterol, dementia), and discussion points of topics including annual examination, osteoporosis, estrogen replacement therapy, vitamins, MRI and back pain, and antibiotics in sinus and bronchitis. The case studies demonstrate the use of the Benefit/Risk Characterization Theater to illustrate key discussion points with patients.

We currently live in a time where many of our patients obtain details about health from the internet, magazines, or other lay people. Without the proper filter in place, the patient will experience challenges in determining what is important and what is not. As physicians, we have a unique opportunity to guide these discussions, but many of us have significant time constraints in the office setting given the current model of health care.

This book offers a visual tool to empower and help the patient think about why decisions are being made with respect to various screenings, tests, or interventions. As we all know, medicine is not black and white. There can be a lot of gray area, and a multitude of factors that impact decisions (or inability of the patient to make them). It is clear that the authors are genuine in their desire to use this tool to help improve doctor-patient communication to facilitate important decisions in health care. We all struggle when trying to craft meaningful discussions surrounding important topics with our patients. Engagement of the patient may help enhance the discussion as we are all sensitized to the pressure of meeting standards and quotas that are linked to the patient’s wellness. This approach is certainly a conversation starter. It may not be for everyone. It took some time for me to fully grasp the concept.

I think that this model could be considered as we train our students, residents, and fellows. It could provide another tool to enrich discussions of maximizing and individualizing health care recommendations instead of a generic “one size fits all” approach. An app utilizing these tools would be ideal, as it could be accessed from a smartphone increasing visibility for both the patient and provider.

Upon initial review, I found the text to be somewhat dry. However, it reminds us that the patient can and should be an active and informed participant in these conversations. The visual chart provides another means to empower the patient (and the patient’s family) in patient-centered care.