Trust is Essential for the Physician-Patient Relationship

By | May 21, 2019
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The majority of literature on trust between physicians and patients focuses on patients believing what their physicians are telling them. Traditionally, the physician has played the role of the single source of information and the patient the receiver without their own level of knowledge. However, with the advancement of technology and research being something searchable at the patient’s fingertips, coupled with a patient’s desire to be part of their health care decisions, more and more patients are coming to their appointments having already done their own research.  As a result, the traditional trust model requires a shift that supports shared decision-making and patient autonomy, thus understanding the level of trust that physicians have in their patients is paramount.

Historically, trust in patients centered on whether they fulfill the physicians’ expectations of them for example: do they adhere to their treatment plan, are they providing accurate information within the context of the physician’s needs, or does the physician believe the patient is manipulating them for some type of personal gain – like prescribing medication. An example of inadequate trust occurs when a physician immediately moves to a differential diagnosis early on in a conversation, which can lead to a physician not hearing the concerns of the individual or understanding the context of the patient’s situation.

Recent studies demonstrate the average time a patient’s opening statements are interrupted is within 11 seconds. This finding is consistent with previous studies from the 1980s, 1990s, and 2000s which all indicated interruption occurred in less than 30 seconds. These interruptions indicate that physicians create a mental model of the situation within that period without hearing the entire context. This dynamic denies the fact that patients are experts concerning their own experience and health. Furthermore, human beings tend to speak in narratives rather than listing bullet point details. Thus, active listening requires translating these conversations into factual information.

Since our patients are vulnerable when they seek our guidance and help, we must also demonstrate vulnerability when appropriate. Trust requires dialog at a human level that encompasses the sharing of not only information but also feelings and hope. We need to move from a model of just dictating what we believe is most appropriate to more conversational models that encompass a broader array of topics, fears, desired outcomes, and situations.  As physicians, we need to understand critical factors that our patients share about their lifestyle such as how they feel about their diagnosis, or are they carrying concerns about the situation of which we are unaware?

Knowing these types of things contributes to both sides understanding one another at a deeper level. It is also important for physicians to pay careful attention to verbal and nonverbal cues. We may catch ourselves and be able to pivot the conversation. All human beings have an implicit bias that can be unconscious. Just understanding this dynamic will aid in better communications. Additionally, inviting the discussion with open-ended questions is a dynamic of trust that is perceivable.

Trust requires us to accept that both the information from the physician and the patient are beneficial for diagnosis and creating treatment strategies for those we serve. If we alter our focus, include the value of information, and how it is presented, not only will our skills elevate, but it will also improve our satisfaction with the relationship. Furthermore, we will better understand our patients.

Understanding the goals and values of those we serve is paramount to our building trusting relationships and elevating the joy in what we do. Let us lift our interactions in a manner that is life-giving to all involved.