Basic approaches to risk study
It is necessary to distinguish two of the existing basis of risk interpretations prevalent in modern scientific and philosophical literature:
1) physicalist interpretation - risk as measurable in probability terms physical event ;
2) pragmatic interpretation - risk as human action under uncertainty.
These interpretations largely complement each other, but they are essentially different points of view.
In the application to the problems of medicine, the physicalist interpretation of risk is important primarily for the study of the internal biomedical properties of medical technologies (pharmacological agents, physical effects through equipment, etc.). The risk is analyzed here by quantitative, probability-statistical methods.
Risk as an action in conditions of uncertainty is closer to specific processes of medical practice. Here the risk is considered in terms of communication, errors, decision-making, organizational characteristics, etc., i.e. from the point of view of the human factor. To study risk as a human action, various methods of social sciences are used.
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Problems of quantitative methods of studying risks
The methods of quantitative specification of the degree of risk arising in this or that situation have acquired immense significance in modern medicine; they are used today in many areas of medical practice and medical research. Let's name some typical applications of quantitative methods.
First of all, quantitative risk assessments are used in connection with the problems of decision-making for different classes of practical problems of medicine and public health. In this case, an updated risk assessment is needed for a formal analysis of available alternatives in order to select the most optimal one; while each of the alternatives is assigned a certain amount of risk, which is then taken into account in the benchmark of the comparative analysis. In assessing alternatives, one or more of the preferences or "utilities" can also be included. patient.
The general methodology of risk assessment and decision choice is developed in special mathematical and applied disciplines (game theory, decision theory, mathematical statistics, technical sciences, etc.). The problems of decision-making in the medical sphere encompass not only the tasks of adopting clinical decisions (but the choice of medical tactics and appointments), but also various managerial decisions (at the level of institutional management, as well as in public health). In these cases, ethical issues of equity and risk distribution may arise.
Risk assessment methods are used to diagnose and develop clinical indications for medical interventions needed, particularly in the field of emergency medicine (eg known threatometric methods). Here, developed statistical approaches are used.
The technical sciences and their applications to the medical sphere solve their own range of tasks for risk assessment. In particular, the risks associated with the operation of medical devices are being studied here.
A wide range of risk studies is also conducted in epidemiological studies. The objectives of such studies are to identify the risk factors affecting the population, assess the hazards of these factors and their social consequences, and also to prove the causal relationship between the effect of risk factors and the onset of adverse effects.
The general method for quantifying the degree of risk consists in assigning some quantitative weight to one or another possible adverse outcome associated with the considered alternative. It is customary to express the magnitude of the risk R of the event X as a product of the amount of the harm generated by this event, A ( X) on the probability of its occurrence P (X). This is the so-called classical risk formula :
R (X) = A (X) • P (X).
It can be used to obtain estimates with varying degrees of accuracy. The quantitative data supplied to it can be empirically justified. For example, information on the probability of an event can be gleaned from the reporting statistics, and the magnitude of the harm can be measured as the cost of economic damage, obtained on the basis of available factual information.
However, in practice, it is not always possible to obtain a quantitative estimate of the risk associated with a particular typical situation or technology. In this case, we have to use only intuitive estimates, although they also try to clarify in some rational way. For example, a common method of clarifying intuitive assertions is to use the expert judgments.
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With regard to procedures for assessing medical risks, the issue of expert judgments remains ambiguous. On the one hand, expert judgments can be very useful as a reflection of the valuable experience of professionals, but on the other hand, they, of course, can not be compared in reliability with information obtained by formal methods in special studies. Thus, significant discrepancies were found between different groups of experts about the clinical interpretation of the same information. However, expert judgments continue to be widely used, as there are many situations where the agreement of experts is the only way to obtain any more accurate estimates.
Thus, in medical science and practice, an extensive set of methods for measuring and assessing risk is used, starting from methodically planned studies (studies of risk factors, technical testing of equipment, etc.) and ending with expert sessions and applying informal, approximate methods of evaluation (estimates by analogy, based on historical data, etc.).
A rational approach to risk management requires that the decision-making uses the most refined data (preferably in quantitative form wherever possible), and the situations to be managed in which the risk occurs are structured on the basis of these updated data .
However, with all the merits of a quantitative approach to risk assessment, it should be noted that the possession of numerical estimates alone is not a means of solving medical problems.
First of all, the quantitative estimates themselves are used in the complex context of clinical, political, social, psychological, ethical and other considerations, and not always quantitative technical information can serve as a decisive factor in the choice of solution. As a rule, the decision makers can at best only include the received updated estimates (with an amendment to their accuracy) in the decision-making procedures. At the same time, quantitative information can make the decision more informed, but can not replace it.
In addition, quantitative data and estimates can not be used in its pure form, but should be further interpreted meaningfully for decision-making. However, any interpretation of quantitative information is inevitably subjective. There is a significant discrepancy between individuals about the assessment of information.
So, the same information can be regarded by one decision-maker as a signal about high risk, and another - as a completely safe or reliably controlled situation. A huge role here is also played by the way information is presented. In special studies it has been repeatedly shown that logically equivalent ways of presenting information can be perceived quite differently. For example, the same probability can be presented to the patient as chances to survive with the help of this treatment (for example, "5 to 1") or in a mirror-like form, i.e. as the chances of not surviving (respectively, "1 to 5"), which will produce a completely different impact on the patient.
Decision making is always an act of independent and responsible choice. Therefore, the ethical decision making component is critical and can not be "eliminated" using various accurate methods and scientifically valid information.
Understanding this has led to the fact that an actively discussed topic in bioethics is the ethical aspects of medical risk. But the reason for the particular importance of the problems of risk in the modern system of medical care and healthcare has become the need for the development of a special research direction - the ethics of risk , which would systematically analyze ethical issues and requirements related to safety and medical risks. >
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