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Risk, Safety and Clinical PracticeHealth care through the lens of risk$
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Bob Heyman, Andy Alaszewski, Monica Shaw, and Mike Titterton

Print publication date: 2009

Print ISBN-13: 9780198569008

Published to Oxford Scholarship Online: February 2010

DOI: 10.1093/acprof:oso/9780198569008.001.0001

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Information about health risks

Information about health risks

Chapter:
(p.123) Chapter 6 Information about health risks
Source:
Risk, Safety and Clinical Practice
Author(s):

Andy Alaszewski

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780198569008.003.06

This chapter reviews attempts to encode evidence in risk guidelines. It argues that doctors have traditionally functioned as expert agents, making decisions for patients without providing full information in order to minimize harm and distress. By the 1970s, this approach had come to be seen as paternalistic. Compliance was replaced, rhetorically at least, by a partnership concordance model. At the same time, the development of encoded knowledge bases has come to be seen as a way of controlling the quality of both service user and expert decision-making. Three limitations of this approach are explored. Firstly, uncritical ‘selling’ of evidence-based healthcare underplays the inherent limitations of risk knowledge. Secondly, encoded knowledge needs to be supplemented by professional judgement in particular cases. Thirdly, policy makers do not always appreciate the contradiction between evidence-based practice and service user empowerment models.

Keywords:   concordance, encoded knowledge, evidence-based healthcare, paternalistic medicine, patient-centred care, risk guidelines, service user preferences

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