The risk of not taking risks There is nothing new about risk but as the SARS CoV2 has shown, decision-making becomes more complex in a crisis, writes Dr Michael Watson. So why is it that two experts can give different opinions about the same situation when using an identical statistics-based risk assessment? The simple answer is that risk assessment is an objective mathematical process but riskbased decision making is more complex and requires subjective assessments of benefit vs risk. The mistake leaders often make is considering the risks of a situation without first considering the benefits. Let’s take patients attending their GP during the COVID-19 crisis as an example. The single focus on the risks of catching the SARS CoV2 virus resulted in patients being too frightened to attend their GP. People with chronic diseases didn’t keep up their usual GP checkins and missed opportunities to prevent minor illnesses from becoming major ones. Were patients undervaluing the benefits their GP’s oversight? I don’t think so, I think people were simply giving in to fear and failing to put the risks into perspective. Government messaging may be partly to blame. The failure of government to adequately monitor the COVID-19 situation and to communicate the true risks to the public played a role. The VirusWAtch surveillance system, which was established in 2007, has been partially defunded and rendered less able to respond to the SARS CoV2 pandemic. If this surveillance system was rebooted and rolled out now to all general practices, the state would have a highly effective early warning system which would renew the confidence of GPs and patients. The cost would be miniscule compared to the benefits of an accurate real-time assessment of the risk this virus actually poses. I am often asked whether WA should now re-open its borders. While it is essential to the economy 6 | JULY 2020
There is a smorgasbord of opportunities to improve our society (and at the same time mitigate the risk of SARS CoV2) that have emerged through this pandemic.
and the future of the state, my answer is still no because I don’t think we have a sufficiently robust and ethical risk-based decisionmaking process in our businesses, organisations and government bodies. This means we are destined to repeat the mistakes of other countries, even though we have successfully bought (at great cost to our community) precious time to prepare ourselves. There is a smorgasbord of opportunities to improve our society (and at the same time mitigate the risk of SARS CoV2) that have emerged through this pandemic. The biggest risk is us not capitalising on the benefits and going back to the bad old ways of doing things. We have uncovered fantastic new ways to improve the environment through reduction in energy consumption and greenhouse gas emissions. We have increased outdoor activities, seen the benefits (for many) of working from home and recognised the importance of local supply chains. Judicious use of telephone consultations and widespread use of video conferencing to avoid unnecessary travel are all examples that will bring long-term benefits which should go a long way to solving many of the problems of the 21st century.
against the potential risks, we can restructure the way we do things to maximise benefit and minimise risk. There is little in life worth doing that does not involve risk. Trying to avoid all risk brings the far greater risk of lost opportunity. We need to get back to football, interstate and overseas travel and the full delivery of health care services, but this will require the government to facilitate a process of sensible risk-based decision making. The architects of that model must be the people. Government officials can’t possibly understand the intricacies of every individual business and organisation in the state. We need our community leaders to be given the freedom to work with their members to promote the benefits of what we do and to develop codes of practice (in conjunction with organisations such as WorkSafe) to help mitigate the risks of SARS CoV2. This is impossible to achieve if we are forbidden from introducing measures to mitigate risk such as NAT testing of asymptomatic individuals. We also need enhanced surveillance systems, funded and coordinated by government (such as VirusWAtch), that will help us monitor and respond to the risks of SARS CoV2 as they evolve.
We need a risk-based decisionmaking framework built on Respect (empathy and compassion i.e. understanding and kindness). By fully understanding the benefits we bring to each other, weighing these MEDICAL FORUM | MEN 'S HEALTH ISSUE
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