Observations The Art of Risk Communication

Should patients listen to how doctors frame messages?

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7091 (Published 27 November 2014) Cite this as: BMJ 2014;349:g7091
  1. Gerd Gigerenzer, director, Harding Centre for Risk Literacy and Centre for Adaptive Behaviour and Cognition, Max Planck Institute for Human Development, Berlin, Germany
  1. gigerenzer{at}mpib-berlin.mpg.de

Different phrasing can change a neutral message to an implicit recommendation

Imagine that a patient with a serious heart disease is considering potentially lethal corrective surgery and asks you what the chances are. Your response can be framed in two different ways—five years after surgery, 90% of patients are still alive (survival frame) or 10% of patients are dead (mortality frame).

Should the patient’s decision depend on how you frame the message? Studies show that people are more inclined to consider surgery when the doctor uses the survival frame (albeit less so when decisions are real rather than hypothetical).1 Isn’t reacting differently to the two frames—called a framing effect—irrational? A 90% chance of survival and a 10% chance of mortality are logically equivalent. In their influential book, Nudge, Thaler …

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