Letters

Communicating risks through analogies

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7417.749 (Published 25 September 2003) Cite this as: BMJ 2003;327:749
  1. Adrian Edwards, reader (a.g.k.edwards@swan.ac.uk)
  1. Primary Care Group Swansea Clinical School, University of Wales, Swansea SA2 8PP

    EDITOR–Articles in this theme issue have described approaches that try to enhance the communication of risk by developing communication skills, using decision aids, and simplifying the representation of information. But when clinicians talk about actual risks with individual patients they often use analogies. We asked visitors to bmj.com to tell us some of their analogies.1 Many of their responses addressed screening and chronic disease–perhaps because they are both particularly fraught with difficulty.



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    The value of illustrations was reinforced by Barth, a surgeon: he described how he gives patients a digital picture of their scan that includes a risk calculation. This, of course, also indicates the extent of disease.

    Many of the examples from readers try to convey the size of a risk. People know, for example, that smoking is a risk but find it difficult to comprehend its magnitude. Mackay relates how Richard Peto (responsible for many of the big studies on the effects of smoking) tosses a coin and slaps it on the back of his hand to illustrate to his audience the (true) 50% risk of being killed from long term tobacco smoking. “It always produces a gasp of surprise.”

    Clinicians may be faced with conveying very small risks. Markowicz relates how he sometimes engages in the following dialogue:

    “Do you know …

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