Risk as­sess­ment crit­i­cal first step in pa­tience care

Prairie Post (East Edition) - - Viewpoints -

Have you ever been stress­ing about some­thing un­likely and had a friend tell you, “Yeah, so. You might get hit by a bus to­mor­row too.”

I don’t want to make my work sound too easy but hon­estly, I think this to my­self at least once a day when work­ing through a huge com­po­nent of my job; risk as­sess­ment. Although in my job as a physi­cian I work with you to pro­tect your health (and as a pub­lic health physi­cian I do that on both an in­di­vid­ual and pop­u­la­tion level), there is no way I, nor any­one else, can pro­tect you from ev­ery risk in the world. Life is risky and one of my jobs is to eval­u­ate the level of risk from a par­tic­u­lar ex­po­sure, ac­tion or in­ac­tion and also to weigh the risk of a par­tic­u­lar in­ter­ven­tion or mit­i­ga­tion strat­egy.

Risk as­sess­ment in­volves iden­ti­fy­ing the haz­ard in ques­tion, de­ter­min­ing the ex­po­sure, cat­e­go­riz­ing the risk in terms of both like­li­hood and sever­ity, and then also as­sess­ing what can be done to limit the risk and whether those op­tions are ef­fec­tive and well-tol­er­ated. Ex­am­ples where I might have to do a risk as­sess­ment for an in­di­vid­ual pa­tient may in­clude a per­son who has poked them­selves with a nee­dle or was bit­ten by an an­i­mal. Ex­am­ples of risk as­sess­ment on a pop­u­la­tion level in­clude as­sess­ing the risk from poor air qual­ity or po­ten­tially-con­tam­i­nated drink­ing wa­ter.

What never ceases to amaze me about risk as­sess­ment is the dif­fer­ence in ev­ery per­son’s level of risk tol­er­ance. I will of­ten be ex­plain­ing to a per­son that their risk from a par­tic­u­lar ex­po­sure is very, very low and yet the per­son may be de­mand­ing drugs for pos­t­ex­po­sure pro­phy­laxis that can be both harm­ful and, in my mind, not in­di­cated based on the level of risk from the ac­tual ex­po­sure. At the same time, that pa­tient may be a heavy smoker, not wear a hel­met while rid­ing an ATV and has un­pro­tected, anony­mous sex. Those de­ci­sions are all more risky and yet get promptly dis­re­garded just be­cause I am men­tion­ing a very mi­nor, pre­vi­ously un­con­sid­ered risk.

I am equally amazed when peo­ple are ex­tremely con­cerned about rare but pos­si­ble risks with vac­ci­na­tion, yet have no prob­lem ac­cept­ing the very real and not un­com­mon risks of the dis­ease the vac­cine is de­signed to pre­vent. You wouldn’t want to get a sore arm or a very rare al­ler­gic re­ac­tion to a vac­cine, but bring on the po­lio???

I won­der if some of this in­con­gruity in our risk tol­er­ance is re­lated to the fact that we don’t want to take re­spon­si­bil­ity for the risks we cre­ate for our­selves but are ok with putting the blame or re­spon­si­bil­ity on other peo­ple?

Re­gard­less, just as ev­ery­one has a dif­fer­ent risk tol­er­ance for in­vest­ing or money man­age­ment (and it took sev­eral at­tempts for my ac­coun­tant to ex­plain to me why squir­rel­ing my money away un­der my mat­tress may be low risk but still not a rea­son­able in­vest­ment strat­egy), so too does ev­ery­one as­sess risks to their health in dif­fer­ent ways. We don’t have to all think the same way but I do hope we can think with rea­son and use science to crit­i­cally as­sess our as­sump­tions and fears.

It is my job (and the job of all health providers) to ed­u­cate our­selves on the science and to ex­plain it clearly to our pa­tients so to­gether we can both as­sess the risk in the spe­cific con­text of the pa­tient. Risk can make any­body ner­vous, so let’s just be sure the ac­tions we take in re­sponse to risk are mo­ti­vated by logic and not sim­ply by fear.

Dr. Lena Derie-Gille­spie is Med­i­cal Of­fi­cer of Health, South Zone. She can be reached by e-mail, Lena.Derie-


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