David Oliver: No more broken promises.

In clinical practice, trust is paramount. We trust team mates to know their job and to hand over well. Patients and families need to trust that we’re competent, compassionate, and acting in good faith. But sometimes, in trying to reassure patients and with the best of intentions, we make promises we shouldn’t. And broken promises damage trust and confidence. Some promises concern what we as individuals or teams will do for patients. For example, “We’ll do our best to get you as well and as close to your usual abilities as we can.” “We will refer you for this test or to that team.” Expert, evidenced, or educated prognostications about how much better or worse a patient might get or what a test or treatment might achieve—these are, partly, promises: “This treatment might improve your pain control and help your mobility, but in your case there’s only a 50/50 chance.”