Health Care and Notions of Risk.(Book review)

HEALTH CARE AND NOTIONS OF RISK Richard C. Clark North Melbourne: Therapeutic Guidelines Ltd, 2004, PB 60 pp, AUD39.00. ISBN 0-9586198-3-2

Many people who specialise in risk have begun to appreciate a central truism of our times, namely that we live in a 'risk society'. Risk has become a form of currency in the modern world and is being used as a conceptual tool for understanding how a range of actors and institutions respond to new technologies, changing global dynamics, concerns about liability, and the evolving nature of shared decision-making under various kinds of uncertainty. In the realm of health care, risk is seen by many practitioners and policy-makers as an indispensable concept for focusing attention on patient safety. In Health Care and Notions of Risk, Richard Clark reviews the results of a national survey of 1501 Australian adults on their experiences with adverse outcomes (medical mistakes), perceptions and preferences about participating in medical decision-making, and perceptions of risks in health care.

To focus his analysis on these experiential, preferential and perceptual issues, Clark begins by reviewing the history of adverse medical events. In this review Clark reflects on the centrality of risk in health care and provides several examples of how medical errors are under-reported, costly to the health care system as a whole, and challenging in terms of the ethical issues that often arise when risky medical interventions are undertaken. The approach here is refreshing and on-target. Instead of discussing risk only in the abstract, he appropriately combines the growing literature on risk perception with a general sociological analysis of the changing nature of medical decision-making. As many now appreciate, a patient-centered approach to health care creates its own challenges but it will invariably benefit from a more nuanced understanding of how patients perceive the risks and benefits of various treatment options.

In his analysis of the national survey, Clark notes that the health care system is perceived as 'moderately safe' when compared to other hazards including tobacco, chemicals in the environment, food handling and nuclear power. Differences by demographic variables like sex, income, age, level of education and region are included in the analysis to provide a richer understanding of how best to ...