Are people becoming silly about risk - egged on by hysterical reporting, an exaggerated belief in human rights and sheer ignorance? If so, clinicians and managers in healthcare organisations need every help they can get, both to understand and manage risk effectively.
This book is a useful addition to the ever-expanding literature, and although it is principally addressed to general practice, will be useful to any manager working within primary care.
The first half aims to help us to understand what risk is and some of the pitfalls in thinking and talking about it.
'Risk is the probability that a hazard will give rise to harm'.
Simple enough to say, but our estimation of hazard will be conditioned by our values and our experience. Some people tolerate high levels of risk because they value their personal freedom, while others are more dependent and will expect to be safeguarded.
The discussion on culture could have perhaps gone a little deeper by examining the apparent decline in our acceptance of fate or God's will, a phenomenon particularly noticeable in the lack of tolerance of any obstetric untoward incident and a subsequent increase in litigation.
But how can we communicate risk to patients and the public?
There is obviously a limit to the use of statistical methods when doctors themselves will admit that they do not always understand their significance. Several examples of useful risk scales are discussed.
The ability to evaluate risk is compromised, not only by patients' intellects, but also by their expectations and fears.
Studies have demonstrated that patients are likely to pick up less than half of what they are told.
The second half of the book first places risk management in the process of clinical governance.
It then adopts Lilley and Lambden's areas of risk in general practice to suggest what can be done.
This list is challenging, but so then are the consequences of failing to assess risk appropriately.
Keeping up to date with changes in clinical practice is particularly difficult, given that some patients will have scrutinized the Internet beforehand and can be well informed.
But equally, popular fallacies can confuse the issue so that no categorical statements should be accepted on trust. As elsewhere, scepticism is a necessary ingredient of progress.
The handling of mistakes requires sensitivity and it is vital that investigation precedes any suggestion of retribution.
Developing trust within the team carries a high priority - not easy with imperatives cascading from on high.
The authors offer a most helpful example of a personal development plan (PDP)which, while it may appear daunting at first, is likely to meet many of a practitioner's questions and anxieties. Far better to be explicit about our perceived shortcomings than to hide them.
Issues from these PDPs can then be aggregated into a plan for the whole practice.
We cannot avoid risk, but at least we can learn to stare it in the face.
Andrew Wall Visiting senior fellow at Birmingham University's Health Services management centre.
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