Electronic letters to:

Review:
P.J. Devereaux, Lee Goldman, Deborah J. Cook, Ken Gilbert, Kate Leslie, and Gordon H. Guyatt
Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk
CMAJ 2005; 173: 627-634 [Abstract] [Full text] [PDF]
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[Read eLetter] Communicating Risk
Tom Vandor   (20 September 2005)

Communicating Risk 20 September 2005
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Tom Vandor
McGill Family Medicine

Send letter to journal:
Re: Communicating Risk

tvandor{at}sympatico.ca Tom Vandor

As physicians we are responsible for clear and honest communication.

Your article on perioperative cardiac risk in the CMAJ- Sept 13, 2005 173 (6) shows how poor we are at this. By passing the editorial screening, it also illustrates how blind we are to this failure.

In the section on page 633, on how to communicate the perioperative risk, it states that low , moderate and high are inadequate but that percentages have more meaning. I invite readers to tell us how they would make a personal decision based on the statement ' (your) risk of cardiac death, nonfatal MI or nonfatal cardiac arrest is 1.5% to 3.5% ‘

If as it is also written there is ‘…uncertainty around the risk estimation data ‘ , then we have to also share with them this uncertainty, yet reassuring them that although there is a risk, most people come through their procedure just fine.

It is an abdication of responsibility to throw numbers at patients. We are their guides as well and as such must also offer our personal judgements based on our experience and reading.

It is also dishonest to state , as it does in the conclusion, that ‘ accurate estimation of risk …is important to allow informed…decision making’ when as it states in the next sentence ‘There is significant uncertainty regarding the predictive accuracy ..of cardiac risk assessment'

Tom Vandor md Ormstown Qc

Conflict of Interest:

None declared