Abstract
The question of risk is a standard feature of medical practice. Yet, it is unclear whether handling of risk is improving as medical practice evolves. An eternal truth is that risk is impossible to eliminate entirely. Even systems that purport to mitigate risk may take a narrow view of risk, mitigating against a single risk while being open to being blind sided by others.
In some ways, every aspect of clinical decision making is an exercise in risk management. Every conversation with a patient is a communication about risk. Every journal article is communicating how best to manage risk. The foundation of risk management is being wise enough to understand that we cannot anticipate every risk, and if we anticipate a risk our plans for mitigation might be unable to control it.
Growth of medical litigation has led to increasingly risk averse medical practice. A red flag system for clinical work can lead to defensive practice that may not serve the best interests of patients willing to accept a degree of risk to improve their lives. 1 One answer here is to reconsider how we view red flags in clinical systems. A second, and a bolder one, is to switch to a system of no-fault compensation.
Another exposure to heightened risk is from the rapidly expanding ecosystem of unregulated and untrustworthy digital information. Most people can struggle to identify trustworthy information. A reality of artificial information is that the closer you are to the topic of an AI generated summary or advice, the more you realise that the summary is replete with misinformation and disinformation. 2 The corollary of this, and a dangerous one too, is that the less you know about a topic the more likely you are to believe that an AI generated summary or a social media post is plausible.
One solution is to search for more information ourselves. Whether that is shunning an AI generated reference list that might include fabricated references and hand searching those references, or not relying on electronic red flags in a point of care clinical system but seeking more information directly from the patient – such as in this month’s example of talking more to patients to better understand the nature and circumstances of a poisoning attempt. 3
We might also take a more structured and evidence based approach. For example, the world of evidence based research seeks to improve clinical research by improving the conduct and reporting of research. Importantly, it also pushes us to systematically evaluate the existing evidence base before we dive into new research or decide on a clinical management plan. 4 We might be busy and we might be passionate about technology, but thinking for ourselves in a structured, evidence-informed manner remains the best form of risk management we possess.