Under-Promising and Over-Delivering in Private Practice

When I first joined private practice in 1994, I was young and new in town. I wowed to work hard to provide the best service to my patients. I was up against the giants in this town so I had to provide services that were superior to what was being provided by my seniors. I brought in new technologies like laparoscopic surgery and IVF. Another strategy I adopted was to “under-promise and over-deliver” in whatever I did. 

What does this term under-promise and over-deliver actually mean? It was a term coined by business author and speaker Tom Peters, in 1987. His concept is to set lower expectations and then deliver more that what was promised. The concept is simple: a good surprise is much better than a bad surprise. In other words, stakeholders would much rather find out their expectations were exceeded than unmet.

Even though it appears like an easy concept to adopt, it was difficult for me to implement. I was trying to promote Laparoscopic surgery over Open surgery and it was difficult for me to under-promise. Under- promising meant that I would have had to tell my patients that even though Laparoscopic surgery was superior to conventional Open surgery, I was not promising that I would always be successful in completing a  surgery laparoscopically. I had to under- promise the technique while promoting its use. This  seemed contradictory. Patients would  look at me, perplexed; perhaps even wondering if I was incompetent.

Even when I was promoting IVF to my patients in 1997, I had to tell them that IVF was a very good option for them but that the pregnancy rates were not all that great. They were informed that they would have to fork out a great deal of  money to undergo IVF which had   a relatively low rate of success. I know of some colleagues in other cities who were quoting the “moon” as their success rates, and many of my patients ended up flocking to them,  abandoning me because I was giving a modest but true success rate of pregnancy after IVF. My motto of under-promising here did not work for me.

Recently I started a new service called HIFU (High Intensity Focused Ultrasound) for fibroids and adenomyosis. I am again, in a situation to decide whether I should adopt the motto of “under-promise and over-deliver”. If I under-promise the effectiveness of HIFU for fibroid and adenomyosis, patients may not choose this option over the traditional myomectomy or hysterectomy. So in order to give my patients confidence to undergo HIFU I have to give them the exact success rates and not under-promise its effectiveness. 

So is under-promising and over-delivering really good for private practice? Let me outline its advantages and disadvantages. 

Advantages of Under-promising and Over-delivering in Private Practice:

  1. Increased Patient Satisfaction: By under-promising and over-delivering, medical professionals can provide a level of care and attention that exceeds patient expectations, leading to improved patient satisfaction. Patients are more likely to feel valued and appreciated when their expectations are exceeded, which can help establish a positive relationship between the patient and the medical professional.
  2. Improved Reputation: Consistently delivering high-quality care and exceeding patient expectations can enhance the reputation of the medical practice. This can help attract new patients and build a strong foundation for future growth and success. By establishing a positive reputation, medical practices can differentiate themselves from competitors and stand out in the market.
  3. Increased Trust: When patients receive care that exceeds their expectations, they are more likely to trust the medical professional and the medical practice. This can help build a strong relationship between the patient and the medical professional;  fostering a sense of loyalty and commitment. Over time, this can lead to improved patient outcomes and a more positive experience for the patient.
  4. Improved Patient Retention: Patients who are satisfied with their care and experience are more likely to return to the medical practice for future treatments and procedures. This can help improve patient retention and increase the financial stability of the medical practice.

Drawbacks of Under-promising and Over-delivering in Medical Practice:

  1. Increased Workload and Stress: By over delivering, doctors may take on additional responsibilities and tasks, leading to increased workload and stress. This can have a negative impact on the well-being and satisfaction of the medical professional, reducing his/her ability to provide high-quality care over time.
  2. Unrealistic Expectations: While under-promising and over-delivering can improve patient satisfaction, it can also create unrealistic expectations for future treatments and procedures. Patients may expect the same level of care and attention for every appointment or procedure, which may not always be possible for the doctors to provide. This can lead to frustration and disappointment for both the patient and the doctor.
  3. Financial Costs: Going above and beyond to exceed patient expectations can also come with financial costs, such as additional staff, resources or equipment. This can impact the financial stability of the medical practice, particularly if the additional costs are not offset by increased patient satisfaction and referrals.
  4. Ethical Considerations: There may be ethical considerations to consider when under-promising and over-delivering, particularly in the context of medical procedures and treatments. For example, providing additional services or resources may be viewed as a conflict of interest or a form of over-treatment, which can raise concerns about the motivations of the doctor.


In conclusion, under-promising and over-delivering is a strategy that can provide numerous benefits for medical practices. However, it is important to consider the potential drawbacks before implementing this approach in a medical setting. Doctors should weigh the benefits and drawbacks carefully, ensuring that they are delivering high-quality care in a responsible and ethical manner that benefits both the patient and the medical practice. By taking a thoughtful and strategic approach, medical practices can improve patient satisfaction, enhance their reputation, and build a strong foundation for future growth and success.

So what advise can I give doctors going into private practice on the  practice of under-promising and over-delivering?

  1. Over-deliver as much as you possibly can but choose “under-promising” carefully. Sometimes under-promising can be seen as a weakness by patients who may think that you are not that competent.
  2. Managing expectations of patients is perhaps one of the most difficult skills to aquire. Every patient needs to be studied, and expectations measured so that you can tailor your promises to their expectations. This can be difficult and tricky. 


Picture of Dr. Selva

Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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