Hope is a therapeutic tool.

Everyone who has been a patient, or accompanied a relative to see a doctor, recognises the importance of the doctor-patient relationship. At its heart is the patient’s need to understand what is wrong, be understood, and be offered hope. Although it is common sense that hope is a fundamental element of overcoming any illness, the clinician’s role in encouraging hope has been framed as one of the distinctive elements of the “art of medicine,” relying on personal experience and instinct. However, hope is in fact a practical therapeutic tool that can be optimised just like any other management approach. Despite the considerable attention given to the doctor-patient relationship during medical training, hope has traditionally been neglected. Many doctors still don’t have a clear idea about how to use hope as therapy while at the same time being realistic and truthful about uncertainty and the potential for poor outcomes. Communication skills training tells us to avoid saying, “You are going to get better,” because there is rarely such certainty and, in the case of poor outcomes, unfulfilled expectations will erode trust. Clinicians are apprehensive about offering false hope and can end up ignoring the question of hope altogether. This is particularly challenging for those of us caring for patients with chronic and progressive diseases—we fear looking incompetent when we have no curative treatments to offer. Hope versus optimism