Education And Debate

How can doctors communicate information about risk more effectively?

BMJ 2003; 327 doi: (Published 25 September 2003) Cite this as: BMJ 2003;327:728
  1. Andy Alaszewski, professor of health studies (,
  2. Tom Horlick-Jones, senior research fellow2
  1. 1Centre for Health Studies, George Allen Wing, University of Kent, Canterbury CT2 7NF
  2. 2School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff CF10 3WT
  1. Correspondence to: A Alaszewski

    Effective communication of risk can improve both individual and national health, and there has been substantial investment in such communication. Has this yielded the anticipated improvements in health?

    In recent years risk has become a mature cross disciplinary topic of study, and during this time social science research into risk has experienced a rapid growth. Despite the existence of much relevant social science knowledge about risk, the extent to which such knowledge has been applied in the health field has been perhaps surprisingly limited. In 2001-2, two UK research councils (the Economic and Social Research Council and Medical Research Council) commissioned us to examine the potential for applying social science knowledge about risk to practical medical and health issues. We have used our findings to tackle the thorny issue of physician-patient communication about health risks.

    Although there has been a substantial growth in the knowledge about the risk factors associated with ill health, the full benefits of such knowledge can be gained only if the experts such as doctors can communicate this knowledge effectively and patients are willing and able to use it in their decisions about treatment and lifestyles. However, we consistently overestimate the dangers and undervalue the benefits we obtain by living in a complex society. For various reasons, we do not think rationally about risk, and this has reached a level where perverse judgments are damaging to society–for example, issues surrounding risks associated with rail travel and the MMR vaccine.1

    Assumption that patients rationally review evidence

    There is little evidence that knowledge of risk as embodied in professional assessments influences the ways in which the general public perceives and responds to risks and dangers.2 Epidemiologists have identified a range of risks associated with different patterns of behaviour–such as the harmful consequences of smoking, alcohol consumption, drug misuse, and “unsafe” sex–and the …

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