Predicting Risk

May 18, 2010

So much of what I do as a physician and as a mother involves predicting risk. At work I continually weigh the risk of heart disease versus the risk of medication side effects, the risk of missing a diagnosis versus the risk of radiation exposure from a CT scan... At home, I try to predict the risk associated with letting my first grader walk to the bus stop alone (too risky) and the risk of him becoming tremendously overweight if he plays videogames too long (acceptable risk).

Last night, while I was getting my youngest to sleep (he was all that stood between me and some downtime), the alarms started going off that indicated we were under a tornado warning. I quickly put him down and checked out weather.com to find out the details.We get pretty frequent tornado warnings and usually ignore them, but this one indicated that our particular (small) town was at risk.

I asked my husband if we should get all the kids out of bed and head down to the basement. This was not a pleasant thought for multiple reasons. He suggested we wait to see if it became windy, which it did a few moments later. So, we rounded up our four little ones and headed downstairs.

They were thrilled, of course. All was well – aside from a knocked over plant and patio chair, there was no damage and the kids had a great time with their unexpected bonus of extra time awake. We were cautious and fortunately the warning was just that, with nothing more serious occurring (in our town, at least).

Yesterday, I was asked to predict the risk of one of my hospitalized patients dying imminently. This is so very tricky. On one hand, you want to be as honest as possible to allow the patient and family time to prepare.

On the other hand, you realize that physicians are notoriously bad at predicting when the end will occur and do not want to prematurely worry the patient or family. I balanced honesty and hope to give my best prediction to a worried spouse. I am sure that this challenging conversation involved me prevaricating a bit as I tried to be kind and encouraging. I was frustrated once again with my inability to predict the risk accurately.

So much of what I do as a physician and as a mother involves predicting risk. At work I continually weigh the risk of heart disease versus the risk of medication side effects, the risk of missing a diagnosis versus the risk of radiation exposure from a CT scan, the risk of a one in a million adverse vaccine event versus a very small risk of acquiring polio.

At home, I try to predict the risk associated with letting my first grader walk to the bus stop alone (too risky) and the risk of him becoming tremendously overweight if he plays videogames too long (acceptable risk).

It is both a burden and a privilege to carry this responsibility – to decide, recommend, advise, predict. Lives may be altered or forever affected by what I decide. If I think about it too long, it can become paralyzing – not knowing which way to go. This is where I ask for help – from my patient, from a colleague, from my husband, or my mother. Their encouragement and experience support me in my role as risk predictor.