I’ve been reflecting on the nature of promises in healthcare over the past few days. Namely, because I can’t give any. To anyone.

For example, you’d be insane to say, “I promise you’ll be OK” or “I promise this will make you feel better” because there’s an excellent chance that NEITHER of those will be true.

Even implicit or oblique promises are dangerous things. For example:

Concerned Parent of Child with Diarrhea: “Well, if I just take him home and give him Pedialyte, will he be OK?”

I can’t really say “yes” because that’s not true — the kid may not be able to keep it down, or may have intractable diarrhea and lose all the fluids right away, and get much, much more ill.

But it’s not like you can just say “No. He’s sick. Stick around and wait another two hours.” As we so gleefully loved to point out in nursing school, that’s not therapeutic communication.

You know, even if I’m 99% sure that something will occur, I can’t promise it, in any way, shape or form. “OK, we’ll get you seen by the doctor, and I’m sure he’ll give you something for pain.”

No, I’m NOT sure, because the MD may find out that this person is an addict and is drug seeking, or may have such severe kidney disease that they can’t tolerate appropriate pain medication.

I can promise people NOTHING.

Which leads us back to the cliche of Death And Taxes. I’m idly sifting through things in my mind right now that are guaranteed, other than those two things, and besides the sun rising and setting, I can’t think of much.

I guess I CAN promise my patients that I will absolutely do my best to be their advocate, to push for the best treatment I can for them, and to support them while they’re here. And I’d like to think that’s true all the time. But it’s a big burden to bear, especially if you don’t actually LIKE your patient. And while I’ve liked all my patients so far, I have no doubt there will come a time when I need to treat someone I detest, and that will, undoubtedly, be a struggle.

In other news, it is pouring here. The forest fires are out, the plants are watered, the roads are flooded, people out rural are unable to get their trucks out of the mud, and monsoon season has begun. Hallelujah.