Posted by: Tony Copperfield25 April 2014
Okay, I’m warning you now, this blog will not feature the usual full-on denunciation of patients, moans about hospital doctors, railing against bureaucracy, calls to napalm the Government. Instead, I’m devoting it to a cluster-randomised trial in a recent edition of the British Journal of General Practice titled: ‘Communicating risk using absolute risk reduction or prolongation of life formats’. So please feel free to slip quietly out the back.
I don’t really want to explain why I was even looking at this paper. Some would argue that there is no life more empty than the one that requires the reading of a cluster-randomised trial in the BJGP, and they might be right. I prefer to suggest I was drawn in involuntarily by noticing the following sentence: ‘Danish GPs were invited to participate...in health prevention consultations’. And: ‘Specially designed risk information sheets served as tools in the health prevention consultations’.
Health promotion? Yes. Illness prevention? Yes. But health prevention? Not unless I’ve missed something fundamental. So let’s put it down to a bad subbing error. Whatever: it got me reading the rest of the paper. Which, in essence, showed that presenting information to punters about ‘absolute risk reduction’ rather than ‘prolongation of life’ – or percentage reduction in 10-year cardiovascular risk versus how much longer you might live, on average – was more likely to have them dutifully collecting their statin prescriptions.
Frankly, I don’t give a monkey’s about that. What I do care about, though, is the brief summary. This is the only bit we ever read – if, indeed, we open the journal at all; if, indeed, we take it out of the wrapper. In particular, I’m referring to the summary’s wording and tone.
It states: ‘The effectiveness of risk communication to patients, judged by their propensity to redeem a prescription for a statin, was greater when information in absolute risk reduction rather than prolongation of life was presented to them.’
Hang on. If ‘effectiveness of risk communication’ equates to how likely patients are to collect their statin, the implication is that our role as effective communicators is to use whatever method of spinning the stats will persuade patients to take medication.
Is that what we GPs are supposed to do? What happened to patient choice? Aren’t we supposed to be providing punters with information to make a decision, not cattle-prodding them to the pharmacy? I have plenty of patients who, after explanation, opt to live with their risk factor rather than pop pills. According to the BJGP, that makes me a bad communicator and them intellectually deficient, or both.
This is the thin end of a horrible wedge. There are many things I don’t want to regress into in my role as a GP, and one of those is an agent of persuasion for a dubious public health policy. Autonomy promotion? Autonomy prevention? Or just another subbing error?