Doctors’ promises

A few days ago my Twitter timeline featured a tweet from a doctor who beseeched his fellow medics not to make promises that “that aren’t in their gift to promise”. I responded with some bewilderment (which was greeted with ‘it happens all the time’).  Here I want to make an account why.

Let’s start with some basics. We all know what promises are, yet, I would like to explore them just a little, using the speech act theory (Austin and Searle). Speech act theorists spoke of ‘felicity conditions’. They are, roughly, conditions under which it makes sense to say something. In other words, conditions under which a particular speech act can be felicitously (or happily) made. And so, what makes a felicitous promise? Well, John Searle in his iconic Speech Acts suggests three fundamental conditions. I follow Gibbs and Delaney in calling them Obligation, Hearer preference and Nonevident.

Thus, a promise places an obligation on the speaker to do what they promised, a promise refers to something that the addressee actually wants to happen and a promise is not done in the ordinary course of events. Yes, things are more complicated, as you can see from Gibbs and Delaney’s article, also judging by political promises, but there is no need to go into more nuancing for the point I am making here.

So what does a doctor making a promise do? Well, she or he places her/himself under obligation to do something. Moreover, and importantly, the doctor will do it ‘specially’, not as a matter of course. The ‘it’ becomes a matter of some priority, something that must happen. The more interesting question, however, is what happens when the doctor can’t actually make the promise, because the ‘it’ is not controlled by her/him (whether the doctor knows it or not, is largely immaterial for the patient).

Now, the consequences of an ‘infelicitous’ promise are to do with the very foundation upon which clinical communication is based – trust.  The broken promise undermines this foundation, invites uncertainty into a situation which is already fraught with uncertainties. Moreover, if I cannot trust you with such a simple thing as keeping your word, what else can I trust you with? But there is more. Your promise constructs my case and dealing with it as special. Whether ‘special’ means that I myself am special or my case is special (serious, urgent?) is immaterial, still, things are out of the ordinary. Your promise might be as much worrying as reassuring. And then the extraordinary falls flat….What I am to think about this?

Why would doctors do it? I would imagine the reasons are simple and obvious. Reassuring, getting the patient/family off their backs, or even empathy. The problem is that the consequences of breaking the promise are anything but empathic. In a nutshell, they undermine the social foundation of my communication with you and, in Austin’s words, abuse the way we communicate and expect others to communicate.

But let’s not forget the power dimension. A broken promise of a doctor is not just any broken promise. It is a broken promise of someone in a position of power and so, you could argue, it hurts me more, while my resources to sanction you for it are minimal.

So here you are, medics: an linguist’s account of promises you cannot keep. There is a simple solution, though. Don’t make them!





Loading ...