Contracting for trust in family practice obstetrics.

A case is presented, illustrating a problem faced by family physicians who practice obstetrics; women who present with lists of inflexible requirements for labor and delivery may be attempting to control a situation in which they feel a great deal of fear, and little trust for the physician. The physician who tries to deal with every item on the list, rather than to explore the meaning of the total presentation, risks establishing a contract that cannot be met-and attracting more demanding patients. It is better to offer to discuss the patient's fear and distrust; this is described as `contracting for trust', and is a way to promote patient and doctor flexibility.