Can't Set Patient Expectations? Understand This
Jun 25, 2025
When I was 13, I asked my mum for a pull-up tower that I'd seen at Rebel Sport. It was approximately $297 and at the time, mum told me that finances were tight... but if I managed to get a few A's at school, she'd buy it for me.
Guess what? Ya boy got 3 A's that year. It wasn't English though. Me no English good in high school (which is funny now that I've written a book).
Anyway, after proudly showing my mum the report card (and copping a stare for my English 'C'), we made plans to buy a pull up tower that evening. Thursday night shopping - off we went.
When we'd got there, I tried to hide my excitement but I was POWERWALKING toward the pull-up tower. I must've walked past it because it was nowhere in sight. I double-backed a couple times. I was certain it was here.
But it wasn't.
Then, my heart dropped. Where the tower used to be, there was a sign. 'Pull up tower... sold out'. I felt my body go hot. My ears turned red. I felt a lump in my throat. I took a few deep breaths in the silence of mum's observation.
I turned around and said 'it's okay, it was too expensive anyway.' My mum, adamant on rewarding me, politely asked the clerk when they'd restock.
'In a week's time,' he said. 'If you leave your details, I can call you when it comes.'
Mum left her details.
I share this story because it's a great example of how you can set an expectation to either impress or disappoint someone. If you want to see how this works, check out the video below. Otherwise, keep reading!
In the story above, I was disappointed - so disappointed I almost cried.
But what if I told you... you could easily flip that emotion by just altering the sequence of events?
The way you set an expectation is by controlling the first piece of information you present to anyone - and this includes your patient.
For example, in the same story above, if the first time I saw the pull-up tower - there was a sign saying 'sold out', I wouldn't be disappointed going there the second time because last time, it was already sold out.
Sold out would be my default expectation.
However, because the first time I saw it - it was in stock, then when I went back, I had the expectation that it would still be there. And that's why... when I did eventually return, I was set up for disappointment.
Now how do we apply this to clinical practise?
Well, when it comes to rehabilitation expectations - you must be cautious of what the first piece of information you provide is. For example, if they have a knee injury, and the best case scenario is 4 week recovery, and this is what you say...
You're most likely setting them up for disappointment. Because 'best case' scenario only happens for a few people.
You are better off being realistic and saying...
'Most knee injuries like this take 6-8 weeks to rehabilitate. There are a few patients who do get better within 4 weeks, but that's usually because they already have a very athletic background.'
Similarly, when I used to perform health consults, I would always tell them the average as the goal, and outline what makes the above-average work.
Most clinicians (especially the young ones) get in the habit of trying to only talk 'best case' scenario because they feel obligated to promise hope (and reject the realistic complications).
But look, if your patient is a smoker, has fatty liver disease, doesn't train, and has chronic lower back pain - do you really think they're a candidate for 'best case scenario?'
In fact, I'd go even deeper psychologically to say that an inability to set realistic expectations actually sets your patient up for failure which can be totally destructive to their goals - whether it be rehab and/or performance.
If you set realistic expectations and they achieve it earlier, they enjoy a nice surprise.
If you set unrealistic expectations and they achieve it later, they may become disappointed.
In the example in the video above, I use Jeremy Lin, an ex-NBA player who created 'Linsanity' a few years ago with his meteoric rise. However, since that season - he hasn't nearly been able to reach the same heights.
This led fans to believe that Lin had 'lost his touch'.
However, the psychological phenomenon of expectations was in effect here.
Firstly, for Lin to be considered a 'break out', there weren't many people that knew who he was. It also helped that he was Asian. So suddenly you have an unknown Asian who performed at that level - surprising everyone who
a) hadn't seen too many Asians in the NBA and
b) had never seen him before
Now fast forward a few seasons and Lin has not been described in the same light. He is also a victim of expectations because...
The ones who became familiar with him via his break out measured him based off his star performances. Hence, without it - they feel that Lin had 'lost his touch.'
So you see, setting high expectations and/or over-promising results actually causes more inconvenience to the patient than setting realistic ones.
It doesn't 'feel' the best to do so, because you'd like to believe you can provide 'best case scenarios' all the time.
Sadly, most patients are not 'best case' patients, so our expectations must reflect that.
Wishing you success,
Phil
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