It's a numbers game: How should physicians inform patients about risk?

A recent Annals of Internal Medicine article on risk communication highlighted the critical role of the physician in influencing patients' treatment decisions. It is not so much what you say, the study suggests, but how you say it that appears to have the biggest impact on whether or not patients consent to a recommended treatment.

In the study, patients were presented with one of three hypothetical outcomes—based on the same clinical trial data—of taking a drug used to prevent heart attacks. Patients were much more likely to consent to the treatment when told that the drug prevented heart attack in one out of 13 patients (number needed to treat) than when they learned that it postponed an attack for two months in all patients (93% vs. 69%). How the same results were expressed, the authors concluded, had a significant impact on the patients' responses.

In this issue, staff writer Stacey Butterfield explores the implications of these findings and the challenges they present for internists. She talks with experts about alternative ways of communicating statistics, which patients of all educational levels often have trouble understanding and interpreting. The article also surveys the available evidence-based decision tools that can help patients—and time-pressed physicians—make informed choices.

This issue also features the second installment of our six-part series on issues and problems frequently encountered in small practices. Senior writer Jessica Berthold explores the sometimes rocky process of going paperless in a small office. From staff resistance to technology glitches, adopting electronic health records can be a frustrating proposition. However, physicians visited by the ACP's Center for Practice Innovation agreed that the eventual benefits are worth the time and money invested. If you are contemplating a move to EHRs, read on to get tips from those who've made a successful transition. Defining your goals, researching the market and communicating with staff are some of the essential elements of a successful EHR implementation plan.

Also look for latest ethical case study from Harvard expert Lachlan Forrow, FACP, on page this page. And let us know what you think of our new staff columns: Web Watch, Regulatory Review and The Campaign Trail. Please email us your comments. We welcome your feedback!

Sincerely,

Janet Colwell
Editor