Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno

Introduction

O voi ch'avete li ‘ntelletti sani, mirate la dottrina che s'asconde sotto ‘l velame de li versi strani [O You possessed of sturdy intellects, observe the teaching that is hidden here Beneath the veil of verses so obscure]

Dante, Inferno, Canto IX, 61-64

Shared decision making between patients and doctors is at the basis of modern medicine. One of the three fundamental principles of the “charter of medical professionalism” in the new millennium is the principle of patient autonomy: “Physicians must empower their patients to make informed decisions about their treatment.”1 The need to obtain free and informed consent is suggested by European and international texts.2 3 How are these principles translated into clinical practice involving radiological and nuclear medicine examinations?

Communicating radiological risk

Every radiological or nuclear medicine examination involves the administration of radiation, with its inherent risk. Life is a risky business, however, and any discussion of risk is complicated by people's tendency to underestimate large risks (such as the risk of dying from smoking tobacco), overestimate small risks (such as that of being struck by lightning), and be more willing to accept higher risks in situations where they think (usually wrongly) that they are in control (such as driving a car rather than being a passenger in an aeroplane).4 A risk of death of one in one million is generally ignored, since we face many risks of such magnitude every day, from travelling 100 miles by car or 1000 miles by aeroplane.4 It is less easy …