The eye of the beholder: ratings of risk using a reliable instrument and identical clinical material.
Risk management is increasingly seen as a task for health professionals. However little is known about how different professionals perceive and rate risk. The purpose of this study was to see if professional background and experience influence how an assessor rates risk. Psychiatric staff were presented with identical clinical information about one case. They were then asked to score the HCR-20. This is a structured clinical assessment and gives a score of between 0 and 40. Higher scores indicate increased risk of future violence. There was a twofold variation in the score from 15 to 30. There was no difference between medical and non-medical staff. However there was a significant difference between different grades of psychiatrists. Senior psychiatrists scored the clinical and risk items significantly lower when compared with junior psychiatrists. There was no significant difference in the scoring of historical items. The twofold variation in the score on the HCR-20 emphasises that risk assessment is a two-way process. Individual differences of assessors may be very important. Our findings suggest that senior psychiatrists score risks as lower. Possible explanations are discussed.
Keown
Patrick
P
Maudsley Hospital, Denmark Hill, London SE5 8AZ.
Buchanan
Alec
A
D001291:Attitude of Health Personnel; D003625:Data Collection; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D009726:Nurses; D011570:Psychiatry; D011581:Psychological Tests; D011584:Psychology; D011591:Psychology, Medical; D015203:Reproducibility of Results; D018570:Risk Assessment; D012308:Risk Management; D014754:Violence / Q000523:psychology*