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Should physicians promise patients anything?

Developing an authentic patient-physician relationship was always one of the most fulfilling aspects of practicing medicine. Having a patient allow me to interact honestly with their real fears and health challenges was rewarding. Practicing pain medicine for many years for those with difficult to control pain, often cancer related, was interesting and challenging.

During those years, many of these patients had been referred from physician to physician and specialty to specialty prior to what they often viewed as their last stop for their problem. They and their family had often traveled many miles and waited more time than they wanted prior to making it to our clinic. They were often suspicious and wary of another physician telling them: “nothing can be done; you’ll need to learn to live with the pain.” After opening the exam room door, our early conversation often reflected those emotions.

After learning from my patients what they feared, what they wanted and what they needed, I asked for permission to share some ground rules for our patient-physician relationship. No one every turned me down! I always shared the same three points. The exchange went like this: “First, I promise I will never lie to you, second, I will tell you when I don’t know, and third, I will not abandon you.”

That 20-second “speech” early in our relationship did more to help their pain control than any diagnostic testing, interventional procedure or medication recommendation I offered them. Of the three promises made, my sense is that the promise not to abandon them was the most helpful. As healthcare became more corporatized, my sense is this promise even had a more positive effect. Nearly as effective was sharing when I did not know the answer to their question. That statement built trust rapidly in our relationship. The three promises were heartfelt and effective. The promises are a sound foundation for any patient-physician relationship.

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