It is often difficult to explain risk management in patient care.  Sometimes it is considered analogous to defensive medicine, but the writer does not consider the 2 concepts synonyms.

In healthcare, the provider does what he is capable for the consulting client, and he maintains safety with practice inside his capacity.  Yet, at the same time, the only certain thing in the world may be uncertainty.  It becomes a true dilemma for the provider if he wants to promise outcomes or the client wishes full comprehension to the future.

If the evolution goes according to expectation, everyone is happy.  While it is difficult to state situations very clearly, the doctor actually tries each time to calculate happenings when the outcome is ‘one step down’. If by fate the outcome is a less favorable one, the doctor should have calculated beforehand that all possible situations are still under his control.  It means that he and resources are able to handle the next worse scenario, and also that it is still possible to mobilize additional resources including material and manpower support.  If answers are affirmative, the doctor may proceed.  If some possibilities may lead to outcomes not manageable by the doctor, setting or allocated resources, the doctor explains to the client and consider alternative pathways and/or providers.

Take an example of preterm 33 week delivery.  Some babies breathe well after birth, but a proportion needs neonatal intensive care. Of course, no problem occurs when the child breathes well after birth  At the same time, the obstetrician calculates together with the family happenings when the child needs additional breathing support, whether equipment, manpower and financial resources in the planned delivery unit may handle the situation safely. He then leads the family to decide where the appropriate birthplace is.

Risk management also entails that the doctor finds problems out instead of waiting for trouble to knock on the door.  Thus follow-ups usually preached to declared normality may not be considered sufficient by the patient especially in the private sector.  Affordable investigations which do not carry very high risk may be deployed more liberally than what is taught in schools, especially when the client/family is the sole subject to accountability.  In all these situations, open discussion on risks and resource allocation are essential.