All treatments in medicine have potential benefits, but also potential risks. Prescribing treatment requires some degree of hope that the patient will be part of the group of people in which treatment benefits outweigh the damages. Patients receiving prescriptions will find no benefit unless they have at least enough hope to follow through on the doctor’s recommendation. Ultimately, the hope may be realized, and the patient’s ailment relieved. However, sometimes hope is in vain: the side effects are intolerable, the therapeutic effect is insufficient, or the surgical procedure is disastrous. The unpredictable nature of medicine means that, regardless of best intentions, hopes will not always be achieved. Instilling “hope”, therefore, requires communication of some level of doubt, to ease understanding when treatments do not go well.
Yet, I have seen doubt damage patients. They stop a blood pressure medication after 2 days because “It’s not working”. They tell me they didn’t pick up a medication because they “didn’t think it would work”. As humans, we like quick fixes, which make treatments like antibiotics so popular. We are fatigued by insidious diseases like diabetes and obesity, which require constant vigilance and daily sacrifice. Doubt overwhelms many patients, and they stop trying. In their most difficult times, they need increased hope, that each effort increases the likelihood of more tomorrows. It is our job as medical practitioners to explain risks, but also to instill hope sufficient for our patients to get the most out of the rest of their life.