In medical field, explaining and guiding the patients on health risk is one of the most important and crucial obligations that doctors have to their patients. Risk can be thought of as an unwanted outcome or as an uncertainty about the occurrence of that outcome.  Nowadays, medical bodies have developed a well-organized knowledge on medical risk and how to manage it effectively in order to help doctors in this matter. Unfortunately, there is only little evidence that show this knowledge had been used and communicate to patients effectively in clinical field. Without effective communication of risk, this growing knowledge is not really useful as it can only give its full benefit if the communication of health risk between the doctors and patients is effective, eventually help patients to decide about the management of illness and their way of life, which give the best outcome based on patients own interest and benefits. We will discuss into details on the problems and barriers to patients’ understanding on health risk and also ways of improving the communication of risk between doctors and patients.
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There are a few factors that contribute to the ineffectiveness of the communication of risk. One of the factors is because patients tend to accept risk with evidence. Without sufficient evidence, patients will find it hard to accept the risk although it is a high risk. As an example, male patients tend to ignore the risk of having breast cancer as it is traditionally thought to be female-related disease although research had shown that this cancer can affect both women and men equally the same.  Because of this cancer are not heard to affect the men as frequent as the women, male patients tend to ignore the probability that they might also get the cancer. Besides, stigma that surrounds the social background of patients might also be the factor of ineffectiveness of communication of risk. Taking the same case of male breast cancer as example, some men are reluctant to acknowledge the presence of breast cancer on them due to the stigma that breast cancer is a flaw to men’s masculinity.  A 1972 review of cases diagnosed since 1900 showed that men waited 18 months, on the average, before seeking medical advice.  This shows that men tend to delay seeking the medical attention and ignore the risks that most men are found with the cancer already spread to other parts of the body.
In doctors’ opinions, this might be an irrational act, as they might think that the cancer should be cured as soon as possible. However, in the eye of the patient, the benefit of delaying the consultation such as he does not have to face the stigma of the people around him and undergoes various treatments that might cause him more pain; have outweigh the cost of the cancer itself that he is willing to endure the pain and the consequences of having the cancer. When the patient had really weigh up the cost and benefit, then, that decision of the patient to delay seeking medical care would be a rational decision to him although the doctors might not have the same opinion as his.
Sometimes, patients also tend to underestimate the cost of common acts such as excessive intake of sugar in daily meals and overestimate the cost of things that are quite rare to happen such as volcano eruption. The reason for this might be due to the fact that the impact of volcano eruption is bigger and more destructive in their opinion compared to the effect of excessive intake of sugar although excess sugar in blood seemed to be a more common cause of health problems eventually leads to fatality, compared to volcano eruption. Patients tend to oversee the volcano eruption’s impact as more damaging compared to taking excess sugar in daily meals may be because they are not actually really clear on the bad effect of taking excess sugar. Because of this, they tend to ignore the risk of it although in medical field, excess intake of sugar can lead to one of the chronic diseases that is diabetes that will then lead to major health problems such as obesity, heart problems such as Coronary Heart Disease (CHD), hypertension, and kidney failure which can also cause death if no preventive measures taken.
In another aspect, other social factors also become the barriers for patients to understand the health risks. One of the social factors is the source of the knowledge and the degree of which the knowledge of certain risks is trusted by patients. Nowadays, when talking about the health risks, doctors are no longer the most trusted source. According to a British study published in the compilation, “Risk Communication and Public Health,” found that instead of doctors, the two most trusted source of knowledge about risks are family and friends.  These two sources of risk information play a significant role in influencing the patients in making a wise decision. This might be due to patients themselves who might trust self-experience of their family and friends more compared to facts that the doctors told them. Patients might think that doctors only talk based on facts only without really experiencing the risks and consequences that what their friends or family might had undergone. Besides, in Dr John Paling’s book, “Helping Patients Understand Risks”, he pointed out that the overabundance of risks information in the internet and other sources can create hesitation in patients’ mind that doctors really have all the information and knowledge about certain risk, decreasing the effectiveness of communicating risks.  This sometimes causes patients to overstate the risks of certain treatments of procedure, thus influencing their decision making.
Furthermore, risk communication could be ineffective due to the patients themselves who think that the health risks have no relevance in their everyday life and in making decision. As an example, although there are many campaigns held to educate people about the bad effect of smoking, there are still many smokers out there that are reluctant to quit smoking. Most of them refuse to accept the facts of the bad effect of smoking because to their experience, even they had smoked for more than 50 years; they are still as healthy as a horse. So, to them, the risks that the medical people kept saying have nothing to do with them, and have no effect on them at all.  This causes the risk communication not only to be ineffective, but had also been refused totally by some smokers. Besides addiction that smoking caused which also prevent smokers from quitting, the other reason that makes them ignore the risk of smoking is because they already have a mindset that all the diseases that smoking caused, such as lung cancer; are only one of the way people can die and they probably get hit by a bus before they die because of those diseases.  This misconception does not only lead to irrational decision making but also cause more harms than benefits to them.
Ineffectiveness in risk communication can lead to other bigger health problems, thus, ways to improve this communication is needed in order to prevent it. In my opinion, there are quite a number of ways that can be used to tackle these issues. It can be done in one-to-one method such as patient-doctor consultation or it can also be done in a mass like organising a campaign. Looking at the bigger scale first, there are two ways in which a campaign could be held. The first one is by organising a general campaign with no specific target group. This type of campaign is usually to educate the public as a whole on health risk. However, this type of campaign might not be that effective as people might tend to ignore it as they might think that the campaign has nothing to do with them. However, having a more specific campaign on certain group of people might give a better result of awareness as this campaign will cater the problems and related issues of certain group of people such as teen due to the fact that problems varies throughout the society gradient. However, the other groups of society that are not focussed on this campaign might not be aware about the risk. Thus, the government should strategize the campaign’s techniques so that the campaign could cater a mass group but not neglecting a much more specific group. For example, the government could start with a general campaign first to create awareness in the society, before begin focussing on the specific group in the society such as the teenagers.
Other than that, doctors can use mass media in distributing the information of risks to public. This is because mass media is the closest medium and the easiest way for information to be passed on to the public. Not only awareness can be created in the public, but also to justify and correct the contradicting risks received from various sources, as there might also be information on risk that had been underestimate or overestimate by others. However, there are still weaknesses in using this method. Information are tend to be filtered by various media. Individuals with different background and education levels also tend to interpret the information differently.
In another aspect which target specific person, doctor-patient consultation would be the best solution for this. As mentioned above, communicating risk to patients is one of the most important responsibilities that doctors have towards their patients. One of the ways the effectiveness of risk communication could be increased is by gaining trust from the patients regarding this issue. There are a few ways in which doctors should do to gain trust. One of the ways is by developing shared experience, knowledge and understanding. The conversation between doctors and patients are known to be engaged in that patients’ personal life to some extent. By sharing the experiences and understanding of matters not only of medical issues but other general issues in life, it will help doctors to build a good relationship with the patients. Not only that, they will also start to gain the trust from their patients. Doctors should also show their sincerity and willingness to work together to help the patients. This will help the patients to put their trust to the doctors if they see that the doctors are really honest want to help them. Besides, the doctors should also know how to handle the situation and how to help patients to decide what is good for them especially when the patient’s emotion comes into the equation. They have to support their patients and at the same time, try to put their medical knowledge to make patients understand better. For example, some alcoholics tend to blame other people to become the reasons for their dependence on alcohol. However, science shows that stress and addiction are so closely intertwined that to recover, people with addictions must learn new ways of coping with stress.  Doctors should explain to their patients about this, and try to help the patients to decide based on their best of interest as they are the best judge for themselves.
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Doctors can also put aside the barriers to patients understanding regarding health risk by providing an understandable explanation to the patients. Sometimes, problems do arise when patient do not understand what doctors are talking about. This might be due to their different level of education and also different background. In my opinion, this misconception could be corrected by proper and further explanations from doctors to patients regarding the risk. As an example, instead of using medical terms in explaining the risk and consequences of the diseases and treatments, doctors can use simplified terms or rephrase the medical terms to patients so that patients have better understanding. Besides, doctors can also use analogies in explaining health risk. Jeffrey K. Pearson, a family physician said that using analogies does help him a lot.  As an example, he will liken things to crossing the street, which can be dangerous, but people can take steps to make it less dangerous, like looking both ways. 
When talking about risk, doctors should never discuss only on risks that they think important, but they also need to mention other risks that they might not take into account because sometimes, the ones that doctors left behind could be the biggest grave to patients as they tend to worry about everything.  Doctors should also be aware of the social and physiological factors or contradicting information on risks that influence the way patients react to information of risk so that doctors could correct it and give them as much information as possible to patients to help them understand diseases or treatment better. Besides evaluating the risks and explaining them to their patients, doctors should also provide information on effectiveness of protective actions so that patients can make their decision wisely based on their own best of interest and benefits.
Doctors might also use comparison to make patients realise on the health risk. As an example, in 1980, Richard Peto explained to ordinary people the quantitative dangers of smoking by using comparison and statistics: “Among an average 1000 young men who smoke cigarettes regularly – about one will be murdered, about six will be killed on the roads, and about 250 will be killed before their time by tobacco.”  Using this way, doctors can highlight the damaging effect of smoking eventually make patients realise that smoking can cause more harm to them, more that one thay can imagine. Using average estimation such as every 8 seconds, someone dies because of smoking;  can also help doctors to explain risks and consequences better to patients.
To me, talking only might not be really effective. Another way that doctors could do is by showing pictures on health risks. As an example, doctors can show pictures on consequences of diseases due to certain habit, such as smokng and taking drugs. By showing these pictures, these patients could put themselves into the boat of the ones in the pictures and think rationally whether they want to experince the same thing or not. Besides, Dr John Paling in his book also said that the usage of chart that include the specifis risk; and simple grafical deciptions of population (1000 people for example) that show how many people being affected and also how many people not affected is really helpful in communicating the risks to the patients as both the positive and negative effects are presented in a balanced manner.  Lastly, to make sure that patients really get the information and really understand the risks, it is possible for the doctors to ask their patients on the risks to test for understanding.
In conclusion, both the doctors and patients must realise that communicating risks between doctors and patients is very important in helping patients to decide what is best for them based on their own interests. Doctors can increase the effectiveness of their communication skills by building trusted relationship with their patients; be aware of contrasting informations of risks, social and physiological factors that might influence the perceptions of patients towards certain health risks; and take into account emotion, levels of education and also the background of patients to ensure that correct methods are used to approach and tackle the issues. Although there are quite a number of problems regarding this communication, doctors must try their best to convey their messege and information of risks as clear as possible because effective communication obout risk will not only helps the patients to choose what is best for them, but it also help doctors to perform one of their biggest responsibilities in medical carrier.
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