206 Being a Doctor After Being a Patient
The Weighing of Risks
Even those who accepted the statistics had to decide how to weigh or
value these risks. How important were various less-than-lethal side ef-
fects, compared to potential benefits? As patients, they often now bal-
anced risk and benefit data differently than they had as physicians. They
also acquired increased awareness of how physicians and patients differed
in evaluating risks and benefits. Physicians may recognize the possibility
of a particular side effect, but weigh that risk differently than the patient
would. As mentioned earlier, Suzanne, who was on lithium, lamented
that her colleagues did not sufficiently value adverse effects such as weight
gain and its implications (e.g., having difficulty finding a partner). Like-
wise, Pascal, the Lebanese internist, spoke of how identification with
patients led him now not to ‘‘blow off mild symptoms.’’
In short, these physicians based many decisions on irrational, sub-
jective factors and emotional states. Statistical data about risks and
benefits served as a kind of Rorschach test that recipients viewed and
interpreted in a variety of subjective ways. Previous experiences, atti-
tudes, and perspectives shaped these doctors’ approaches toward data in
treating patients and themselves. Indeed, other research has shown that
the physician’s ‘‘practice style,’’ not the patient’s prognosis, affects the
number of tests doctors order in ICUs (13).
Relatedly, patients, and to a lesser degree, physicians, did not fully
understand the meanings of numbers alone, and consequently wanted
qualitative verbal interpretations of data (e.g., ‘‘good’’ or ‘‘bad’’). How-
ever, studies have demonstrated that numerical presentations of data are
more effective than verbal ones, and less subject to individual variation.
Nonetheless, neither quantitative nor qualitative data were always easy
to obtain.
Consequently, in presenting statistics to patients, doctors need to be
highly aware of these emotional and interpersonal factors. This need has
several implications for education and care. For example, the Internet
may never fully replace human contact in providing data, since only
through face-to-face contact can a physician read and respond to non-
verbal, as well as verbal, emotional cues. Medical education also can
better sensitize trainees to how and to what extent patients perceive and
weigh risks and benefits differently than do providers.