Intended for healthcare professionals

Education And Debate

Strategies to help patients understand risks

BMJ 2003; 327 doi: (Published 25 September 2003) Cite this as: BMJ 2003;327:745
  1. John Paling (, research director1
  1. 1Risk Communication Institute,5822 NW 91 Boulevard,Gainesville,FL 32653,USA

    Explaining risks to patients in an effective way is an essential part of ensuring that consent is “informed.” A consultant in risk communication discusses the strategies that can help doctors to communicate risks clearly, and thereby also build closer relationships with their patients

    Fig 2

    Paling Perspective Scale ©–for giving perspective to risks of low order of probability.16 From research report by Small P et al17

    Fig 3

    Paling Palette© –for displaying most medical risks with a probability of higher than 1 in 1000.16 The doctor or genetic counsellor fills in the relevant data while sitting beside the patient. This format shows the estimates of positive and negative outcomes simultaneously and presents unambiguous visual representations of the probabilities. The patient may take a printout home for further consideration, or the form may be signed by the patient and a copy kept on file

    Fig 4

    Revised Paling Perspective Scale© –for displaying risks covering widely different orders of magnitude16

    Effective risk communication is the basis for informed patient consent for medical treatment, yet until recently doctors have lagged behind other professionals in learning this skill. In other industries where risks have to be conveyed to the public (such as chemical, nuclear, water, and food industries) usually only a few people carry out this task on behalf of their organisations and they are specially trained. In contrast, in health care (where the risks are usually far higher and more uncertain and complex) almost every doctor who interacts with patients has to communicate information on risk, yet few have any training.

    Specific strategies can help to remedy this deficiency and improve patients' understanding of risks. Doctors can now choose from a “toolbox” of simple, practical, time efficient techniques that benefit the widest possible variety of patients.


    I have taught risk communication in risk prone professions …

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