Personal (clinician) responses to risk

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Chapter 6 Personal (clinician) responses to risk

Within health care, clinicians are exposed to risks every day. Patients are exposed to risk, clinicians take risks and they sometimes put themselves at risk. Occasionally (perhaps often) clinicians feel that they carry all the risk or they find themselves saying, ‘We can’t take the risk’. Murphy (2002) comments, ‘Apart from the need to assess and manage risk, it also has an emotional component for all concerned and often a judgmental aspect.’¹ Undrill (2007) says, ‘Risk assessment has become a large and anxiety provoking part of the work of many psychiatrists.’²

Personal response to risk may vary from moment-to-moment and day-to-day. Sometimes it is easy to manage the risk and at other times clinicians may be more likely to avoid dealing with problems. In other situations, clinicians may be surrounded by so much risk that they become blasé about it.

The risk thermostat ³

The risk thermostat is a conceptual, qualitative model of how behaviour in risky situations is influenced by perceptions and attitudes. Cultural theory explains risk-taking behaviour by the operation of filters. It postulates that behaviour is governed by the probable costs and benefits of alternative courses of action which are perceived through filters formed from all the previous incidents and associations in the risk-taker’s life. This is shown diagrammatically in Figure 6.1.

Figure 6.1 The risk thermostat

Exercise 1

Below is a continuum which can be useful to consider when faced with a risk problem. The continuum characterises the alternative courses of action which will have been considered when risk decisions were taken previously. It allows for a consideration of where your risk thermostat is set at any given time and how the setting may change in different circumstances.

Imagine a recent episode in which you managed risk and ask yourself where you were on this continuum. Was the issue being managed by being risk-avoidant or risk-taking or was it being managed in a balanced way which required you or your team to be in the middle of the continuum?

Figure 6.2 Risk continuum

Most clinicians move up and down this continuum depending on many different factors. On the whole, it is easier to be risk-avoidant or blithely risk-taking. Sitting in the middle of the continuum (the preferred position) requires more effort, thought and interaction with the patient and their family. Setting the risk thermostat in the middle of the continuum may mean a slightly greater degree of anxiety on the part of the clinician as he/she will need to be more conscious of the possibility of an adverse outcome.

This is shown diagrammatically in Figure 6.3

Figure 6.3 Effort required depending on risk thermostat settings

In practice, it is more common to veer towards the risk-avoidant end of the continuum as this is driven not just by anxiety, but also high workload and limited knowledge base. Clinicians at the risk-taking end of the continuum are more likely to be working in situations where higher levels of risk are dealt with on a daily basis and they become desensitised to the level of risk; for example, crisis teams and inpatient units.

BOX 6.1 PRACTICE TIP

If individual clinicians feel or say that they are ‘carrying risk’ or feel burdened by the risk or say that they ‘can’t take the risk’, it usually means that they are not ‘managing the risk’ effectively.

Personal factors that may affect risk management

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