A Cardiologist’s Advice: How to Set Realistic Expectations About Treatment Outcomes

Keck Medicine of USC cardiologist Oana Maria Penciu, MD, describes how she manages patients’ expectations of the results of treatment.

Oana Maria Penciu, MD, is a cardiologist with the USC Cardiac and Vascular Institute, part of Keck Medicine of USC. Penciu treats a wide range of cardiovascular conditions such as high blood pressure, coronary artery disease, heart rhythm disorders, cardiomyopathies and heart failure. Here, she discusses how she communicates with patients and sets realistic expectations about treatment outcomes ahead of time.

Why is it important to make sure a patient understands ahead of being treated what you as their doctor believes are realistic treatment outcomes?

I see the relationship with my patients as a partnership based on trust and honesty. I think it is essential to talk with my patients about what they can realistically expect from treatment. My goal is to create a treatment plan that fits each patient’s life, expectations and priorities. By setting realistic goals and acknowledging both the possibilities and the limits of medicine, I make sure my patients feel informed, engaged, respected and supported. This way, they are better prepared and more confident in the decisions we make together.

How often do you run into a situation in which a patient or a patient’s loved ones have expectations of treatment that deviate significantly from your own?

As a physician, situations in which a patient or their loved ones have expectations that differ from my own do happen, although they are not that frequent.

Medicine is a complex mix of science, personal values and experiences, so such differences are natural. My role is to support patients in their decisions, if I believe they are safe, and to help find a solution that works for them — even if it’s not the choice I would have made myself.

In cardiology, positive outcomes usually mean that patients respond well to treatment. They feel better, their quality of life improves and they can engage in the activities they enjoy without limitations. Sometimes I see patients regain a sense of control over their lives, which is truly rewarding. Positive outcomes may be going back to windsurfing or basketball; taking care of the grandkids and driving them around; or being present at their children’s graduation or wedding. It also includes favorable test results, such as imaging or lab studies.

At the same time, unexpected outcomes can occur. Medications may cause side effects, procedures carry small risks or the disease may progress despite our best efforts. My goal is to guide my patients through these possibilities, adjust treatment as needed and help them make decisions that align with their life and priorities.

Do you often find yourself having to explain not only to a patient but also a patient’s loved ones which treatment outcomes are realistic?

Yes, I do, and I appreciate and encourage involving loved ones. With the patient’s consent, I include family or caregivers in these conversations to make sure everyone understands what the treatment can and cannot achieve. Having this support often improves adherence and increases the likelihood of a good outcome.

How do you communicate that there is always a margin of uncertainty, error or variability?

This is one of the hardest, but also one of the most important, parts of practicing medicine.

One of my guiding principles is to normalize uncertainty in medicine. I recognize and explain that medicine is not an exact science. Evidence and experience guide decisions; however, every individual is unique. That’s why treatment must be tailored to each person and why it’s so important to set realistic expectations together.

I talk about uncertainty in a way that is honest and realistic rather than overwhelming. Everything in life carries some degree of uncertainty, and all our actions carry the possibility of error. In medicine, this means that while we use the best evidence and our experience to guide care, outcomes can never be guaranteed.

How do you handle situations in which a patient feels frustrated that they haven’t recovered as well as they’d hoped to or are not “cured” or “back to 100%”? What next steps do you take?

This is, unfortunately, a common and sensitive challenge in medicine. I believe that all valuable conversations start with listening, so I take time to acknowledge and validate my patients’ feelings of frustration and disappointment. I remind them that recovery is often non-linear, and progress may be more challenging and take longer than expected. Together, we review the plan, goals and steps already taken and then rediscuss the path forward. Clear, ongoing communication is key to helping patients feel supported, optimistic and engaged in their recovery.

How do you handle situations in which the reason a patient hasn’t recovered as well as hoped is because the patient hasn’t been adhering to medical instructions during recovery?

My goal is always to maintain trust, keep communication open and empower patients to reengage in their recovery, so I start by trying to understand their point of view. I want to identify the challenges — whether it’s misunderstanding, concerns about side effects, actual side effects, or cost — and then address them.

A situation I encounter frequently is confusion about medications, especially when multiple providers are involved or when there’s a communication or language barrier. To make sure we’re aligned, I often ask patients to bring their actual medication bottles to the visit so we can review them together, clarify instructions and address any concerns directly.

Do you ever run into a situation in which a different doctor your patient consulted with promised unrealistic results and now your patient believes these results should be possible?

Occasionally, patients come to me after consulting another doctor who promised outcomes that are unlikely or unrealistic. Often, discrepancies between expectations and reality arise from misunderstandings or poor communication, so I make it a priority to spend extra time listening, reviewing and understanding both their perspectives and their understanding of the situation.

I review all available information and test results and sometimes recommend additional testing that may provide valuable insights. I do my best to help patients understand realistic expectations and work with them on a treatment plan that aligns with their goals while remaining safe and effective.

How do you handle discussing potential outcomes with a patient whose condition is rare/complex and it’s difficult to determine what the outcome of treatment will be?

When a patient has a rare or complex condition, it can be difficult to predict exactly how treatment will go. I make sure to explain what we know, what is less certain and the range of possible outcomes. These conversations often take time and patience, as the information can be complex and emotionally challenging.

I like to give my patients space to process and understand, using a “take one step at a time” approach. Together, we discuss the condition, its implications on daily life, treatment options and possible outcomes, and then focus on the immediate next steps. We meet or talk as often as needed.

A more common scenario is an unexpected, life-altering diagnosis in someone who is otherwise highly functional and healthy — for example, severe valve disease requiring surgery or an arrhythmia necessitating a pacemaker. Receiving such a diagnosis is difficult, and my goal is to support patients through both the emotional and medical aspects of care and help them adjust to a new life.

How does setting realistic expectations align with maintaining your reputation and trustworthiness as a physician?

Setting realistic expectations is central to maintaining your reputation and trustworthiness as a physician. It directly reflects integrity, honesty, transparency and professionalism. I always tell my patients that I like to be open and upfront, which can sometimes come across as too blunt and may feel overwhelming, but most patients appreciate the honesty.

Being upfront about what a treatment can achieve, and confessing potential limitations, helps build trust. Patients recognize that you prioritize their well-being over impressing them or taking unnecessary risks.

Uncertainty is less frightening if patients know they won’t face it alone.

Do you have any final tips to share about how physicians should discuss expectations of treatment outcomes with patients?

When discussing treatment with my patients, I always start by listening. I try to understand their expectations, life goals, priorities and values. I explain their condition in clear, understandable terms, often using analogies related to their profession, and visual aids like pictures, videos or drawings when helpful. I describe the need for treatment, how it works and give an approximate timeline. I set frequent checkpoints for questions and clarifications, and I go over possible outcomes — ideal, less-than-ideal and alternative options — so patients feel informed, supported and confident in the decisions we make together.

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