Communicating Therapeutic Risks

I guess everyone has a cousin Ernest. He is the fellow of whom your mother asks . . . "Why can''t you be more like your cousin Ernest?" Cousin Ernest went to the high school for genius children and got all A''s, even in French. As the years went by, I lost contact with Cousin Ernest. Then last year, at a family gathering, I met him again. Sure enough, he had gone to Harvard and become a doctor, a radiologist. We began discussing his practice and he mentioned that he performs some fairly risky diagnostic tests. While legally he was compelled to tell patients about the risks they were undertaking, he said that risk disclosure was a useless exercise. "No one has ever refused to undergo the procedure," he said. It was difficult to argue with his observation that no patient ever refused to undergo his tests. I understood that the lack of refusals did not necessarily mean that risk disclosure was a useless exercise, but his underlying argument was quite compelling.