Viva Vitality: Risk assessment and making decisions based logic, not fear

By Medicine Hat News on November 30, 2018.

Have you ever been stressing about something unlikely and had a friend tell you, “Yeah, so. You might get hit by a bus tomorrow too.”

I don’t want to make my work sound too easy but honestly, I think this to myself at least once a day when working through a huge component of my job — risk assessment. Although in my job as a physician I work with you to protect your health (and as a public health physician I do that on both an individual and population level), there is no way I, nor anyone else, can protect you from every risk in the world. Life is risky and one of my jobs is to evaluate the level of risk from a particular exposure, action or inaction and also to weigh the risk of a particular intervention or mitigation strategy.

Risk assessment involves identifying the hazard in question, determining the exposure, categorizing the risk in terms of both likelihood and severity, and then also assessing what can be done to limit the risk and whether those options are effective and well-tolerated. Examples where I might have to do a risk assessment for an individual patient may include a person who has poked themselves with a needle or was bitten by an animal. Examples of risk assessment on a population level include assessing the risk from poor air quality or potentially-contaminated drinking water.

What never ceases to amaze me about risk assessment is the difference in every person’s level of risk tolerance. I will often be explaining to a person that their risk from a particular exposure is very, very low and yet the person may be demanding drugs for post-exposure prophylaxis that can be both harmful and, in my mind, not indicated based on the level of risk from the actual exposure. At the same time, that patient may be a heavy smoker, not wear a helmet while riding an ATV and has unprotected, anonymous sex. Those decisions are all more risky and yet get promptly disregarded just because I am mentioning a very minor, previously unconsidered risk.

I am equally amazed when people are extremely concerned about rare but possible risks with vaccination, yet have no problem accepting the very real and not uncommon risks of the disease the vaccine is designed to prevent. You wouldn’t want to get a sore arm or a very rare allergic reaction to a vaccine, but bring on the polio?

I wonder if some of this incongruity in our risk tolerance is related to the fact that we don’t want to take responsibility for the risks we create for ourselves but are OK with putting the blame or responsibility on other people?

Regardless, just as everyone has a different risk tolerance for investing or money management (and it took several attempts for my accountant to explain to me why squirreling my money away under my mattress may be low risk but still not a reasonable investment strategy), so too does everyone assess risks to their health in different ways. We don’t have to all think the same way but I do hope we can think with reason and use science to critically assess our assumptions and fears.

It is my job (and the job of all health providers) to educate ourselves on the science and to explain it clearly to our patients so together we can both assess the risk in the specific context of the patient. Risk can make anybody nervous, so let’s just be sure the actions we take in response to risk are motivated by logic and not simply by fear.