The dangers of risk management

Does making things as safe as possible for children actually hinder the development of safe behaviour later in life?

Dr Cristina Warren, GP, Dublin, Ireland

June 6, 2024

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  • The Botanic Gardens in Montpellier in southern France  are the oldest medicinal botanic gardens in Europe. Incredibly, this wonderful space and piece of history is largely uncared for and overgrown. Somehow, the overall effect of this neglect is charming. (How French!) The Medical School in Montpellier has impressive credentials too, it’s the oldest continuously running medical school in the world. Nostradamus was briefly a pupil before he was kicked out for having worked as an apothecary. I wonder did he see that coming?

    Certainly a loss to the profession. Foresight must be a great thing, especially for a medic. In place of clairvoyance, the rest of us must utilise risk management. Appetite for risk varies between individuals, but I would imagine GPs must have a slightly higher tolerance for ‘living with uncertainty’?

    As I write this I’m out of the office and away on holiday in this lovely place. I’m beginning to wonder if my risk radar needs some recalibration. On a daily basis our sons have been pushing the boundaries of health and safety. Eating food off the street, letting dogs lick their ice-cream and unexpectedly running out into oncoming traffic. Finally, the aforementioned botanic gardens seemed to offer us a break from the gauntlet we had been running all week.

    We stopped to throw a few pebbles into a lily pond. Bothering frogs is a favourite pastime. Suddenly we heard the splash. The older fellow was gone. Then the flailing began and the little sun hat was bobbing up and down. I knew the water was shallow, I kneeled at the side and tried to call him to me but the splashing was beyond my reach and then I heard my husband who was further away holding the baby shout “Just get in and grab him!” Which I then did. It was over in less than 20 seconds. 

    The pond water was everywhere. My shoes were filled with squelchy slime, something was wriggling in the silt on my leg, our son was screaming as we stripped off his sodden t-shirt and shorts… and then there was the smell. It was a full sensory assault. A family story in the making and a holiday disaster, thankfully, averted.

    Ten minutes later he was asleep in the pram, totally exhausted by the fright. “Why did it take so long for you to get in there?” My husband asked. Luckily for our marriage he managed to successfully find a tone that was not judgemental or angry but genuinely curious. I thought about this. I didn’t know. I jokingly answered, “It’s the training. First rule of medicine: never run to an arrest”. 

    A tour group had observed everything. They gave us space, and politely moved on. As we exited the garden a little later one of their party, an older lady with a wiry, diminutive frame and a kind face (again, how French!) came over to see was our son ok. We said we thought he was and she concluded thoughtfully that it was probably a valuable lesson. It was unclear if the lesson was for him or for us. Both probably. 

    Risk tolerance and risk minimisation is a juggle. Proportionality is hard to get right and the approach to risk changes like any other trend. Highly publicised freak accidents may carry undue weight, while more prosaic but impactful adjustments are often ignored. In the 1980s no child was left alone with a plastic bag, but at the same time no seatbelts were worn by children in the back seat of cars.

    In more recent years most things for children have been made as safe as possible. There is a theory that this hinders the development of safe behaviours. We are now seeing a counter-movement that allows for a controlled exposure to risk at a young age. For example, there is now a push to make playgrounds slightly more dangerous. There are many benefits cited but part of the thinking is that a broken arm falling from the monkey bars will mitigate more dangerous behaviour in the same individual as an adult. 

    So should there have been a fence around the pond? Nope; I’m with the new wave playground designers on this one. It was a lesson for my son and a lesson for us. We need to be more careful, but removal of all obstacles and dangers is unrealistic. 

    I don’t have this risk thing figured out by any means. I have always heard that when kids are quiet you should worry. We had never had a chance to experience this sort of silence first hand until last week on a sunny afternoon. It was indeed an eerie thing and I decided to check. Up in his bedroom the three-year-old had no pants on and was laughing to himself mischievously. “What have you been up to and where are your pants?!” “I pee-peed on the roof!” he responded with floods of laughter. I began to giggle with shock. He had opened his bedroom window, climbed out and stepped onto the apexed roof of the extension. The trickle of urine on the tiles corroborated his narrative. 

    In this instance there was no lesson for him but a lesson for me. I will continue to tell myself you can’t control for everything in life or general practice. But you can at least lock the upstairs windows.

    © Medmedia Publications/Forum, Journal of the ICGP 2024