Explaining the Risks.

I just finished reading about Midwife with a Knife's very busy day. It was fascinating. One of the things mentioned is the difficulty explaining risk to patients. I don't know whether the concepts are just hard for some people to understand, or if it's the stress factor that makes the difference.

Our neonatologists and NNPs have to explain risks and benefits to our patients both prenatally and after admission to the NICU. Time after time, I see them explain something in great detail, ask if there are any questions, answer them (if asked) and walk away. The parents then turn to me and say something like: "So the baby will be OK, right?" (far more rarely they predict a dire outcome)

This is when I insert my statistics speech, in which I basically explain that statistics apply to populations and that their baby is an individual. Chances are whatever they were just told that (good outcome or poor outcome) will apply to their baby, but there are no guarantees - and would they like to talk to the NNP or physician some more? The answer is usually no, not because they understand, but because they are overwhelmed. I always pass that information along so the parents can be counseled a little more when they might be better able to understand.

There is one situation that makes it clear just how hard probabilities are to teach. That is when the parent of an infant with an autosomal recessive genetic disorder for which there is a fairly clear 1 in 4 chance of transmission (Cystic Fibrosis, Phenylketonuria, Sickle Cell disease, etc) has a second second child with the same condition and says: "We knew there was a 1 in 4 chance, but we thought that since the first one had this, the next 3 would be fine."