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Editor's Correspondence
October 22, 2001

Communications of Adverse Effects of Medications: Physician Challenges and Informatics Readiness

Arch Intern Med. 2001;161(19):2387. doi:

I read with great interest the article by Ziegler et al1 on patients' views about learning more about medication adverse effects. This study suggests discordance between expectation of patients and physician encounter.

Outpatient practice presents with numerous challenges to the physician-patient encounter. Braddock et al,2 in a study of outpatient decision making using the mnemonic PAR to remind the physician to disclose the nature of Procedure, Alternatives, and Risks involved in any consent discussion, identified that about 33.4% of the visits to primary care physicians involved discussion about medications. They reported that clinical discussion was complete in only 4.6% of cases using the PAR technique. An expert's perception of risk is based on the likelihood of risk and potential outcome of risk, such as disease, injury, and death. Patients, however, evaluate risk as a combination of likelihood of risk × outcome of risk × outrage factors.3 Outrage factors are determined by the perceived severity and resulting public outrage for particular risks.4 Adverse effects of drugs with lower-risk characteristics are perceived as "less severe" and provoke less outrage than other statically similar adverse effects with higher-risk characteristics.

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