Making poor choices by misjudging the level of risk

by STEVEN KUSSIN, MD on August 5th, 2012 in PATIENT-

Risks are not certainties. They are the possibility that an activity will end badly. Risk is a handmaiden to almost everything we do.

Life itself is risky. Every decision is associated with the possibility of harm. Risk can’t be avoided, but it can be managed. Let’s talk today about the chances we take while living our everyday lives.
Risks are subject to a variety of misconceptions. What’s risky and what’s not is often a function of our personalities. Those who are risk averse put their money in the bank. Average risk takers may invest in a group of stocks rather than putting all their eggs in one basket. The risk takers will play the market and dabble in derivatives.

Risk averse? Take a nice walk in the woods. Average risk takers? Don cross country skis and glide through the woods. High risk takers will ski, barreling down the steep mountains in those woods. Those who are risk tolerant feel that, “Only those who will risk going too far can possibly find out how far one can go.” (T. S. Eliot). That’s fine for your pastimes but risky to your lifelines.

We are inundated with advice about risk taking. Much of it is wrong. More of it is silly. Sit back and think a bit. Are you a risk taker or will you avoid many of life’s pleasures to avoid taking chances. What’s your profile? Rise averse? Well the roofing repair career may not be for you. One in six are injured per year. And if you drive to your job the chances are 1 in 12 that you’ll have an accident this year, to boot. If you opted for a small car the chances are that the accident will leave you twice as likely to die than if you bought a large one.

We do many things by necessity. But a lot of what we do and the risks we take are choice. Based on your tolerance for risk, you might start asking questions about the risks of recommended tests and decide whether they are for you. A lot in medicine is elective. It’s here that choice rules. At the doctor’s office, you may decline the test whose risks are clear and immediate, however rare. This will be particularly true if the benefits are small, population based or play out far into the future.

Risk assessment

The rub is most of us are bad at judging risk. Our guesses about the magnitude of risk and the true dangers we face are often at odds. Even if we think we are being careful, we overestimate the risk of some activates and underrate the harms of others.

What’s the risk of dying from a heart attack? Most people guess about one in twenty. It’s one in three. A car accident? The perceived risk averages a guesstimate of about one in 70,000. It’s more like one in 7,000. That’s a 1000% magnitude of error. We land up protecting ourselves against the unlikely while failing to take precautions against activities that are more likely to harm us.

Planes, trains and automobiles

What is the safest mode of transportation? Nope, it’s not air travel. It’s intercitybus travel and streetcars.

Did you know that some observers think a couple of glasses of milk may be more dangerous than a couple of glasses of wine? Would you sooner walk along the street or fire up your Harley? No, again. It turns out you are twice as safe on the hog than on a jog.

Do you want to decrease your carbon footprint? Sure. We all want to save the planet and it doesn’t hurt that we are saving money too. When our homes are insulated and our wood fireplaces are burning we feel good. But it pays to know that the sprayed insulation material emits fumes that pose a health risk. And wood burning fireplace belches out carcinogenic particulate matter that becomes trapped in your now airtight home. Is it better that your home is green or that your face is blue?

Those who don’t want to take chances want to make sure everything in the baby’s room contains fire retardants. But the chlorinated Tris are known carcinogens. Long banned from your babies’ pajamas they are in almost every item in the nursery. It’s injury by fire today versus the chance of developmental problems and cancer later. It’s a tradeoff.

“Sorry kids, no fireworks! Help dad set up the grill.”

Okay, but the chance of death and injury are far, far greater preparing the barbeque lunch than preparing fireworks’ launch.

Love foreign travel? You are aware of the far greater risks you take when placing yourself in the hands of pilots, planes, guides, strange neighborhoods, miscommunication and infectious disease than when at home.

But all those things are what you face in the medical system. And here, the risks are far more dangerous. You may not ever make a foreign journey, but you will someday go on a gurney journey. Risks are inevitable, but please let’s make them calculated risks.

You hop on commercial aircraft with barely a care. Would you set foot on that jumbo jet if you knew that one fell to earth every day killing all aboard? Not a chance. But 15,000 Medicare recipients die a month due to faulty care. Yes, you read that right. And that’s the equivalent of a packed commercial jet crashing a day. And that doesn’t include all the rest of the people in the country under 65. It doesn’t take into account the lesser injuries to the mind, body and wallet. Yet when you check into our offices and hospitals you are trusting. Why is that? It’s the false assessment of risk while in our hands.

When we misjudge the level of risk we can easily make choices that are ill-informed. We land up doing things and avoiding others, purportedly in the pursuit of health, only to find ourselves in even more peril.