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Views & Reviews Review of the Week

Dare to know: risk illiteracy and shared decision making

BMJ 2011; 342 doi: (Published 06 April 2011) Cite this as: BMJ 2011;342:d2075
  1. Iona Heath, president, Royal College of General Practitioners
  1. iona.heath22{at}

Many doctors and most patients do not understand the medical evidence, but shared decision making requires both to have the necessary information. Iona Heath supports the tenets of this book but not its verbosity

The health of nations is undermined by inadequate health literacy, and particularly by failures of statistical literacy, among doctors, patients, journalists, and policy makers. This conviction led to the convening of a meeting of the Ernst Strüngman Forum to discuss to find ways to combat this problem. The meeting was convened in Frankfurt am Main in October 2009, and this book summarises those deliberations and represents with remarkable accuracy all the strengths, but also perhaps the weaknesses, of such a process.

The best part of the book presents a devastating dissection of the statistical illiteracy of doctors. To give just one example, 160 German gynaecologists were provided with the information needed to calculate the chances that a woman with a positive screening mammogram actually has breast cancer: a prevalence of 1%, a sensitivity of 90%, and a false-positive rate of 9%. The doctors were asked, “What would you tell a woman who tested positive that her chances were of having …

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