The Patient Promise:
A Unique Approach to Introducing
Partnership into the Clinician-Patient Relationship
Chronic Disease
The rapid increase in lifestyle-associated chronic
disease, notably obesity and diabetes, poses a
significant problem both at the individual and societal
level. Even with present levels of awareness and
education, healthcare professionals often succumb to
the same lifestyle-associated conditions; for example,
approximately one in four physicians is obese and one
in three is overweight. Mounting evidence shows that
this not only adversely affects the health and
performance of the individual clinician; it also
negatively affects the doctor-patient relationship due
to serious issues such as lack of credibility and less
likelihood of encouraging patients to address lifestyle
behaviors.
Clinician Health
In 1974, there was a high prevalence of smoking among
US healthcare professionals:
18.8% 31.7%
of Physicians of Nurses
As research began to confirm the significant health
consequences of this lifestyle choice, its acceptance
within the culture of medicine changed. This was
reflected in a precipitous decline in smoking rates, such
that today it is only seen in:
3% 8%
of Physicians of Nurses
Research has shown that this trend has important
consequences for patients as well. Physicians who do
not smoke are more likely to encourage their patients
to quit smoking than clinicians who do smoke.
Though clinicians have largely overcome smoking, they
now often succumb to the same lifestyle-associated
chronic diseases that their patients do; for example,
approximately one in four physicians is obese and one
in three is overweight. Mounting evidence shows that
this not only adversely affects the health and
performance of the individual clinician; it also
negatively affects the doctor-patient relationship due to
serious issues such as lack of credibility and less
likelihood of encouraging patients to address lifestyle
behaviors. Recent evidence includes:
About The Patient Promise Hippocrates, Not Hypocrisy
“Example is not the main thing in influencing Learn More & Sign The Patient Promise!
“Let thy food be thy medicine, and thy medicine be thy food.”
others. It is the only thing.” Website: www.ThePatientPromise.org
- Albert Schweitzer, Physician and Nobel Peace Prize Laureate (1875-1965)
E-mail: info@ThePatientPromise.org “Walking is man’s best medicine”
The Patient Promise is a unique commitment between Facebook: www.Facebook.com/ThePatientPromise - Hippocrates, Father of Western Medicine (460 B.C. – 370 B.C.)
healthcare professionals and patients that aims to instill a About the Symbol
deep sense of partnership into their relationship and, The symbol of The Patient Promise aims to
Health professionals take the Hippocratic Oath to express their
in the process, change the culture of healthcare for the represent the major themes embedded within the
oath. One motif that emerged was that many of
commitment to patient care. Similarly we should practice what
better. The promise encourages clinicians to improve the key words and foundational concepts of The
Patient Promise begin with the letter “P”:
Hippocrates recognized many years ago – and avoid hypocrisy
their well-being, oppose weight discrimination, and Patient
– by making the commitment to lead by example and
as a result improve patient health. Promise
Healthcare Professional:
incorporate healthy lifestyle behaviors into our own lives.
The text of The Patient Promise was written by members
Practitioner, Provider, Physician Leading by Example
Partnership
Preventive Medicine “Like many Americans, I used to eat too much and
of the Johns Hopkins School of Medicine Class of 2015. Health Promotion exercise too little. I couldn’t resist a plate of fresh-baked
Along with national experts in clinician well-being and
goodies, and had lots of excuses about why there was
Since “P” is also the most anthropomorphic of the never time to work out. But two years ago, I found
patient interaction, dozens of Hopkins SOM & SON
letters, facing two Ps towards each other both willpower and time upon learning that I was
conceptually represents a conversation between at risk for diabetes…In the first six months of my new
faculty, administrators, physicians, nurses, and patients
the Patient and the Healthcare Professional.
routine, I lost 25 pounds, about 12% of my weight. I’ve
Symmetry is important because The Patient
Promise emphasizes the need for the Patient and kept that off ever since. My percentage of body fat went
provided feedback that profoundly shaped the final Healthcare Professional to view each other as from 24% to 14%...I’ve never felt more fit.”
equals in their pursuit of healthier lifestyles.
version of The Patient Promise, seen below. Finally, the Ps are interlocked to symbolize the -Dr. Francis Collins: Director, National Institutes of Health
renewed sense of partnership moving forward.
The Patient Promise The Movement
The Patient Promise is a movement that will achieve its goal
As a healthcare professional, I understand that: of improving patient health by improving clinician health
through the following methods:
• Our society is increasingly burdened by chronic diseases, many of which may be minimized or even prevented
through healthy lifestyle behaviors. • Partnership - Rather than a coach-pupil relationship,
The Patient Promise places the clinician and the patient
• My role within this society is to restore, maintain, and enhance the health of my patient by offering guidance, hope, on a shared journey towards healthier living.
and advocacy.
• Accountability - Making a public declaration towards
• My actions and inactions reflect my priorities, influence my credibility, and affect the well-being of my patient.
healthier living makes clinicians accountable to their
• My position therefore calls me to lead by example and practice healthy lifestyle behaviors comparable to those I patients, and vice versa.
would ask of my patient.
• Education - The Patient Promise website includes
Thus for the sake of my health and that of my patient, I promise to work towards the following ideals: practical information on how to make improvements to
one’s health, even within the confines of the busy
• I will engage in regular physical activity. lifestyle of a modern healthcare professional.
• I will consume a balanced and nutritious diet. • Awareness – Public expressions of The Patient
Promise – such as white coat lapel pins or waiting
• I will refrain from the use of harmful substances. room wall hangings – provide a natural way for
clinicians and patients to discuss lifestyle-associated
• I will diminish personal stressors and look after my mental well-being. chronic disease.
• I will encourage my patient to adopt these healthy lifestyle behaviors. • Advocacy – Once The Patient Promise has spread
widely among healthcare professionals, healthy-
• I will work alongside my patient as a partner in this journey. minded clinicians will be able to work towards
improvements that make healthy living easier.
• I will identify and guard myself from potential prejudices against my patient based on unhealthy behaviors,
recognizing the often complex origins of these habits.
• I will respect and seek to understand the beliefs and traditions of my patient that affect his or her health. Acknowledgements
• I will do my part to promote healthy lifestyle behaviors within my community. We are grateful for the tremendous support of our
advisors at and beyond Johns Hopkins. In particular we
Recognizing that enduring change of this nature requires time and continual reinforcement, I make this promise freely would like to thank Dean Thomas Koenig, Dean Sarah
and upon my honor to myself and to my patient. Clever, Dr. Erica Frank, Dr. Eric Bass, The Office of Student
Affairs, and the Osler Center for Clinical Excellence.