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ALiEM Bookclub: Risk Savvy

Nikita Joshi, MD |

41SdxtBgsPL._SY344_BO1,204,203,200_The full title of Gerd Gigerenzer’s book is Risk Savvy: How to Make Good Decisions [Amazon], which is exactly what makes this book so relevant, not just to the everyday reader, but to the medical reader. We make decisions every day in the medical field that range from the complex of intubating someone with low reserve or difficult airway anatomy to the less life-and-death decision of when to best time a quick food break between seeing patients. Of course, we also help our patients make very complex decisions, especially in the ED when time is short but risk can be high. And it certainly is not an easy task to attempt to bring family members up to speed on the ins and outs of intubation vs BiPAP or the complex statistics associated with radiation exposure when working up a pregnant patient with a potential pulmonary embolism. Gigerenzer’s book does a beautiful job of helping the reader not only understand how to break down the complexity of risk, but also how to go about explaining it.

Brief Synopsis

Author Gerd Gigerenzer is a psychologist and Director at the Max Planck Institute for Human Development and Director of the Harding Center for Risk Literacy in Berlin, Germany. With his publications and research endeavors, his top focus has been on training people in better decision making through the understanding of risk and uncertainties. This noble goal continues with his 2014 publication of Risk Savvy. The book has 3 main sections divided into the following chapters:

  1. Psychology of Risk
  2. Getting Risk Savvy
  3. Start Early (where he describes how to teach risk literacy)

Chapters that are particularly relevant to the medical practitioner include:

  1. Defensive Decision Making
  2. What Doctors Need to Know
  3. Healthcare: No Decision About Me Without Me

However all the chapters are entertaining and ripe with real world examples that help make the concepts concrete and easy to understand.

Clinical Relevance

Being risk literate is critical to the modern healthcare practitioner and the patient. According to Gigerenzer:

The challenge is to recognize that much confusion about medical statistics is due to non-transparent framing – the rule rather than the exception in health care. 1

Gigerenzer goes to great lengths in the book on the concept that not only is risk literacy vital, but that there is an art of communicating risk. Difficulties in the communication of risk are abound because more often numbers and statistics are misinterpreted and the reference for numbers are missing. A great example that he presents is the Pill Scare in the 1960’s in Great Britain. The UK Committee on Safety in Medicines issued a warning that third generation oral contraceptive pills increased the risk of thrombosis twofold (100%). What they failed to clarify was that this represented an absolute risk increase of only 1/7,000 and that the 100% was only the relative risk. This gross skewing of numbers led to significant consequences such as the rise of unintended pregnancy as women stopped using birth control pills.

The chapter on Defensive Decision Making also gets at the heart of why medical practitioners behave the way they do in the era of high litigation. In the pursuit of reducing uncertainty to the lowest possible amount, many tests are ordered, often excessively. But Gigerenzer offers advice that can be taken by the patient and the practitioner. Rather than simply ordering a battery of tests or providing a wide range of treatment, or from the patient perspective, allowing a battery of tests/treatments to be performed – ask instead:

  • What is the benefit of the treatment?
  • What is the reference class of the statistics being provided (50% of what?)
  • What precisely is meant by success?
  • What are the harms of the treatment?
  • Who financed the study?

Medical Educational Relevance

In the third chapter of the book, Gigerenzer discusses his vision of teaching risk literacy that begins with childhood. He believes that early education can eventually lead to a new generation who inherently understands complex statistics intuitively, without having to calculate complex mathematics. If what he lays out can be taught to 4th graders, then hopefully medical practitioners can also get on board during the early parts of the medical educational training. And the way to do this is to encourage the teaching of abstract decision making and statistics throughout medical training. He outlines two principles:

  1. Teach problem-solving in the real world.
  2. Don’t teach for tests, teach for life.

Gigerenzer ends the book with the final section titled:

“Everyone can learn to deal with risk and uncertainty.”

And with this hope – pick up this fantastic book and get motivated to become risk literate!

Bookclub Questions

  1. In the perfect world with unlimited resources, how would you redesign the medical curriculum to teach learners about statistics?
  2. How can medical practitioners use their knowledge of risk and statistics to avoid defensive decision making?
  3. What role can medical practitioners play in educating the general public about statistics and risk with regard to medical testing?

Gerd Gigerenzer at TEDxZurich 2013

Disclaimer: We have no affiliations financial or otherwise with the authors, the books, or Amazon.

Gigerenzer G. Making sense of health statistics. Bull World Health Organ. 2009;87(8):567. [PubMed]

Author information

Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University

The post ALiEM Bookclub: Risk Savvy appeared first on ALiEM.

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