PI Brief Update

How GPs Manage Uncertainty - Dr Mark Burgin

01/12/23. Dr. Mark Burgin BM BCh (oxon) MRCGP explains the unique relationship that GPs develop with risk so that they can help patients see their choices.

Risk pervades every part of medicine so GPs in their work consider the chance of a side effect, the likelihood of a diagnosis and the prognosis of cancer.

Although many clinical negligence cases contain the words ‘low risk for …’, in general GPs’ assessments perform better than risk calculation tools.

Communication of risk is part of that skill as is making a holistic assessment as they empower the patient by considering what is important to them so their decision is clearer.

Understanding how patients respond to risk allows the GP to see where the thresholds that guide decisions both to the individual and patients in general.

Communicating risk

Explained badly risk is one of the most troubling aspects of medicine causing health anxiety (worried well) with associated learned helplessness.

Detecting a risk factor for a disease can be more disabling that having the disease itself particularly if the patient finds numbers difficult to understand.

Explaining that the risk factor is wearing away the system and that failure can be put off or brought forward by the patient’s actions empowers patients to make changes.

Using the ageing model is one way of communicating risk so that patients can make sense of the information that is given to them without distress.

Holistic assessments

The biopsychosocial model BPSM does not restrict the concept of risk to a few test results that can be measured but a broader view of how life effects illness.

The BPSM seeing risk in what we do is closer to patient’s own view of their life where bad choices can have bad consequences in unexpected ways.

The more risk factors the GP is aware of the more opportunities to change the overall level of risk particularly the hidden risk factors such as psychosocial problems.

It can seem strange to a non GP when specialists do not address a patient’s problem when it is preventing good quality care.

Thresholds of risk.

Typically risk increases with age so a young person may not consider their risks as important whereas an older person can be overwhelmed.

This way of seeing risk as whether you need to do something about the risk now or whether the risk can wait until later is useful when a young patient’s risk is high.

If a patient has a real chance of getting the disease in the next 10 years most of them will already have the disease or its precursors so treatment is appropriate.

The GP tailors the available options to the level of risk so that where there is a good treatment to prevent an illness the threshold for using that will be low.

Conclusions

Risk can either interfere with a patient’s well being or creep up on them until it is too late, and the GP has ways of managing this uncertainty.

The words that the GP uses to communicate risk can empower or disempower a patient and make changes straight forward or feel impossible.

By listening to the patient’s own descriptions of their life the GP can see the whole picture and work out where changes will be easiest or possible.

Thresholds are an important concept in showing how risk has meaning to the patient can help them feel in control of their choices.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

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