Chapter 5 The context of risk
Knowledge and clinical skill are helpful but do not inoculate the clinician against the discomfort of uncertainty.1
Clinical risk assessment should be motivated primarily by the intention to provide a patient with better treatment and care.2
These two positions can be shown diagrammatically, as seen in Figure 5.1.
Other contextual factors are not necessarily related to the patient or the relationship that the clinician has with the patient. There may be personal factors with the clinician, dynamic problems within the clinician’s team and difficulties accessing resources in which to manage the risk.
It is necessary to expand the previous thinking about the dynamic situational factors and divide these into patient-related factors and non-patient related factors (see the flow chart in Figure 5.2).
In the ‘other factors’ circle, consideration can be given to other issues that may influence the risk and the outcome. These may include:
• situational factors that are not directly related to the patient but are more related to the wider social environment, such as culture, ethnicity, religion, psycho-social influences, and so forth
• physical environment concerns; for example, the layout of an inpatient ward, whether a potentially violent patient is being seen in a forensic setting or in their home, and so forth
• personal (clinician) responses to the risk (see Chapter 6)
• multidisciplinary team (MDT) and other systemic responses to the risk (see Chapter 7)
• resources available for managing the risk and the clinical condition.
