Risk tells us that uncertainty exists about a specific outcome.1 Particularly when great uncertainty exists about the outcome of a procedure, the communication of risk is challenging and difficult. Medical jargon and statistics have been employed to project scientific objectivity to help manage the emotional load that often accompanies discussions in which great uncertainty exists. These approaches may create distance between physicians and patients and raise questions about informed consent. Interestingly, little attention has been focused on this physician–patient interaction, leaving best practice about the communication of high risk unknown.2 How then are we to proceed to discuss risk with our patients?

In the 1 August issue of Heart, Schaufel et al3 bravely explored the nature of patient–physician dialogues about high-risk cardiac procedures. The authors invited us to consider that communication regarding high-risk procedures is about more than the procedure and the likelihood of complications and death; it is about unspoken aspects of the human condition for both the patient and the physician. It is particularly striking that these critical conversations were of relatively short duration—6–16 minutes. This is somewhat staggering if one considers the complexity of the legal, ethical and existential aspects involved in the course of communicating risk and obtaining informed consent.

Communicating risk places great demands on both the physician and the patient. Complicated information must be translated by the physician using words or numbers that the individual before him can comprehend; the information must be imparted in a way that the physician …