Many of us get confused by claims of how much the risk of a heart attack, for example, might be reduced by taking medicine for it. And doctors can get confused, too. Just ask Karen Sepucha. She runs the Health Decisions Sciences Center at Boston's Massachusetts General Hospital. A few years ago she surveyed primary care physicians, and asked how confident they were in their ability to talk about numbers and probabilities with patients. “What we found surprised us a little bit,” Sepucha says. “Only about 20 percent of the physicians said they were very comfortable using numbers and explaining probabilities to patients.”
Doctors, including Leigh Simmons, typically prefer words. Simmons is an internist and part of a group practice that provides primary care at Mass General. “As doctors we tend to often use words like, 'very small risk,' 'very unlikely,' 'very rare,' 'very likely,' 'high risk,' ” she says. But those words can be unclear to a patient. “People may hear 'small risk,' and what they hear is very different from what I've got in my mind,” she says. “Or what's a very small risk to me, it's a very big deal to you if it's happened to a family member.” Simmons and her colleagues are working on ways to involve their patients in shared decision-making. The initiative at Mass General gives patients online, written and visual information to help them. One of the goals is to make risk understandable — bridging the gap between percent probabilities and words.