Power and control: contracts and the patient-physician relationship.

Contracts with patients have become increasingly common in clinical practice and the medical literature. These include behavioral contracts for managing “difficult patients” , opioid contracts, suicide prevention contracts, and healthy living contracts. Some physician practices have even asked patients to sign contracts promising not to litigate or post defamatory comments on the Internet. Despite widespread adoption, few have stopped to consider the potential risks and ethical concerns with using these documents. This perspective will describe how patient contracts are ultimately about power and control, and if not used carefully could damage the patient-physician relationship.