Abstract
Risk communication has become a central legal and ethical component of shared decision-making. This talk explores the roots of observed problems in risk communication using a Foucauldian ‘genealogy of problems’.
My focus is on ethnographic data from the recent NIHR I-DECIDE study on consultations about total knee replacement, a common surgery where a minority of cases result in unintended outcomes with devastating effects. The data shows that discussions of risks suffer from a variety of putative pathologies. Risks presented in a conversational manner were used evaluatively in pursuit of certain outcomes, while presenting lists in more ‘neutral’ ways had nugatory effects on the observed decision-making process. Discussions of risk often lacked depth or treated risks dismissively, and risk communication was sometimes deferred or abandoned by both patients and surgeons.
To theorise reasons for these pathologies, I explore the genealogy of risk, considering the social context of the development of frequentist statistics and the underlying philosophy of marketising reforms of healthcare. These genealogical roots of risk reveal that, far from being poor practice, communication of risks is likely to be inherently persuasive, that risks may have limitations in informing individual outcomes that may make them lack relevance to decision-making, and that the potential of risk communication to improve decision-making may be overplayed in policy due to ideological biases.
I end by arguing that a more nuanced understanding of risk communication is needed if we are to improve shared decision-making in practice.