Presenting Risks

Enhancing Patients’ Treatment Adherence

The human brain did not evolve to manage large numbers.  Our prehistoric ancestors probably didn’t have to count past 3 very often; the idea of 100 wasn’t a consideration.  Today, we need to communicate to patients risks of 1 in 1,000 or 1 in 10,000.  Patients don’t handle these numbers well.

The human brain hears about the chance of a rare event and it thinks, “There’s a chance!”  This may be why so many people play the lottery.  There may only be a 1 in 100 million chance of being the winner, and people think there’s a good chance it may be them.  The brain cannot accurately weight such a small event.

This can become a problem when we have a patient suffering from some disease, and when we cannot get them to consider appropriate therapy because they heard there’s a risk of something.  They may translate a 1 in 1,000 risk to, “there’s a risk,” and “it could be me,” mentally blowing the tiny risk totally out of proportion.

There’s a simple solution that can help put such risks in perspective.  Instead of telling people there’s a 1 in 1,000 risk, we can tell them that, “999 out of 1,000 patients don’t have a problem.”  To the human brain, “999 out of 1,000 safe” is much, much more reassuring than “1 in 1,000 has a bad outcome.”

I had the opportunity to illustrate this to a group of learners when a patient suffering from skin disease reported that he wasn’t going to take any of the internal options because he heard that there was a risk of liver disease.  I asked him, “Would you take it if 99 out of 100 patients don’t have a liver problem with the medication?”  He said, thoughtfully, “Yes, that would be ok.”  Then I asked him, “But what if there was a 1 in 1,000 risk of liver damage?”  He immediately said, “No way!”

Look at it this way.  How many lottery tickets would they sell if the advertisements said, “You have a 99,999,999 chance out of 100,000,000 of losing.”

Dr. Steven Feldman is a professor of dermatology and public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC, where he studies patients’ adherence to treatment. He is also Chief Science Officer of Causa Reseach, an adherence solutions company, founder of and author of “Compartments”.