Tom Nolan’s research reviews—10 November 2022

How not to discuss anticoagulationLet’s begin with a toe curling qualitative study that analysed 37 clinical encounters between doctors in the US and patients about starting anticoagulants for atrial fibrillation. The quotes in the paper look more like excerpts from a Panorama investigation or a book called What not to say to patients: “[Anticoagulants] reduce your stroke rate from 10% a year down to 2%, and there are generally no side effects except that you bruise easier.” None of the encounters included a balanced discussion of benefits versus risks: “I am very uncomfortable not having you on [an anticoagulant] because you’re going to have a stroke.” The authors called this persuasive language, which roughly translates in everyday language to a guilt trip: “The whole idea is to prevent, God forbid, a stroke, okay? Because if a stroke happens we can’t do anything about it, but right now we can prevent…
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