Recently an NPR story http://www.npr.org * noted: “Many of us get confused by claims of how much the risk of a heart attack, for example, might be reduced by taking medicine for it. And doctors can get confused, too.”
“Just ask Karen Sepucha. She runs the Health Decisions Sciences Center at Boston’s Massachusetts General Hospital. A few years ago she surveyed primary care physicians, and asked how confident they were in their ability to talk about numbers and probabilities with patients.”What we found surprised us a little bit,” Sepucha says. “Only about 20 percent of the physicians said they were very comfortable using numbers and explaining probabilities to patients.” “
“Doctors, including Leigh Simmons, typically prefer words. Simmons is an internist and part of a group practice that provides primary care at Mass General. “As doctors we tend to often use words like, ‘very small risk,’ ‘very unlikely,’ ‘very rare,’ ‘very likely,’ ‘high risk,’ ” she says.”
“But those words can be unclear to a patient.”People may hear ‘small risk,’ and what they hear is very different from what I’ve got in my mind,” she says. “Or what’s a very small risk to me, it’s a very big deal to you if it’s happened to a family member.”
“Simmons and her colleagues are working on ways to involve their patients in shared decision-making. The initiative at Mass General gives patients online, written and visual information to help them. One of the goals is to make risk understandable — bridging the gap between percent probabilities and words.
“The Food and Drug Administration also likes numbers and urges drug companies to give numerical values for risk — and to avoid using vague terms such as “rare, infrequent and frequent.” But the European Medicines Agency (a part of the European Union) has matched a scale of terms — very common, common, uncommon, rare and very rare — with numerical definitions for each of those five levels of frequency. So, what percent of cases qualified for the top level “very common” side effect? You might think over 50 percent, but according to those EU definitions, a side effect is “very common” if occurs in more than 10 percent of cases.”And if a drug label says that a particular side effect was “very rare”? That means it occurs in fewer than one in every 10,000 cases.
* to read the full NPR story, “For Better Treatment, Doctors And Patients Share The Decisions” by NPR staff, highlight and click on open hyperlink http://www.npr.org/blogs/health/2014/07/24/333719559/for-better-treatment-doctors-and-patients-share-the-decisions?utm_campaign=KHN%3A+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=13584115&_hsenc=p2ANqtz-9JGhvTy9xT_S_f7JfBG6x3Oyo4vSHFjhTI8M4L0lAK8DFG7r2HEPb8W4mZvWQTwu11pT81TWUF4KcF1H7-SalhZHCN_lHr0RcRKwDCfGrylTFl19g&_hsmi=13584115
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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration
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