Patient Trust and the State of the Doctor-Patient Relationship
While it might seem that trust in doctors is at an all-time low, a recent poll revealed that 7/10 Americans still trust doctors, nurses, and pharmacists to do what’s right for them and their families all or most of the time. So what is the reason when a patient does not follow the doctor’s orders? As it turns out, many things have an impact on patient trust.
Poor experiences in the past
Some patients don’t trust the medical system because of poor experiences in the past. This experience might be as simple as a previous negative encounter with a doctor or hospital, or as complex as historical discrimination against certain religious or ethnic groups.
Some patients may feel they are not treated fairly by the medical system due to their income, insurance, or ability to pay for their medical care. Others may feel that their doctors don’t understand or can’t empathize with what they’re going through due to differences in their economic, ethnic or educational backgrounds. These factors all contribute to an individual patient’s trust in their medical doctors.
The influence of social media
In addition to previous experiences, there is increasing evidence that a doctor’s behavior on social media can have an impact on patient trust. With more and more doctors having online profiles on various social media websites, their personal lives and opinions are more on display than ever before. If a doctor shares private or offensive information online, it can damage the trust that individual patients have in them, as well as erode trust in the medical system at large. Before the proliferation of online social media platforms, a doctor’s personal life might have been largely a mystery to their patients. In the age of the internet, however, a doctor’s behavior is on display for everyone to see. It’s essential to preserving patient trust that doctors behave professionally online – and if they don’t, it may even cost them their jobs.
Beyond the behavior of individual physicians, social media can also be used to spread false or misleading medical information that can undermine trust in doctors. While social media can be a great way to communicate with others, there is often no guarantee that the information exchanged is factually accurate. When that information conflicts with what a doctor is telling you, especially if it comes from a source you trust, you may lose trust in your physician in particular, or the healthcare system in general. While some social media sites have made attempts to fact-check information, the internet remains a source of false and misleading information that can cause mistrust.
Consequences of a Lack of Trust
When patients don’t trust their doctors, there can be consequences that negatively impact their health. Patients who trust their doctors report performing more beneficial health behaviors and having fewer symptoms and overall a better quality of life compared to those who don’t. Patient adherence to treatment is widely recognized to be one of the major benefits of having a trusting relationship with a healthcare provider. When patients trust their doctors, they’re more likely to make incremental changes in their health over time. Having a doctor you trust means you have someone you can go to with questions about new information and want to verify if information is true or not, or if you’re simply unsure about a recommended treatment or screening. If problems do arise when using a medicine, a trusting relationship with a doctor can help to determine what the problem is and whether there are alternative treatment options.
When patients don’t trust their doctors, they’re less likely to ask them about the risks of recommended treatments. They may even not reveal their nonadherence to treatment at all!
In addition to potentially harming their health, patients who don’t have a trusting relationship with a doctor may become distrustful of the medical system in general.
People who don’t already have a doctor they trust are less likely to trust in health care overall.
This mistrust often leads people to avoid visits to doctor’s offices and hospitals altogether, even when they have an emergency in need of treatment. It can also drive them online or to sources outside of medicine seeking answers, which can potentially cause more harm than good.
Building a trusting relationship with a doctor doesn’t usually happen overnight. It can take years of working with a patient to get to the point where trust is a two-way street. In some ways, the most simple way to build trust with a patient is also the hardest – listening to their concerns. There is no one strategy for trust-building that works for every single patient. Each patient will bring to you different challenges and impressions in terms of what they are afraid of and what they are hoping to achieve in the short time they are in your office, ER, or under your care in a hospital. However, there are some simple techniques that you can use to improve your listening skills and build trust with your patients.
Being comfortable with silence
One good tactic for trust-building is to start by becoming comfortable with silence and listening. In medical school, we learned that the average doctor interrupts their patients within 11 seconds of them talking. Imagine if every time you tried to talk, you were interrupted before you got to the point! Patients are often eager to share the symptoms that brought them to see the doctor today, if they are only given the time to present them.
To get used to allowing patients time to talk, practice sitting in silence for 30 seconds. This can be a useful exercise to get used to listening quietly when a patient starts to talk. While it will initially feel like a long time, increasing your comfort with silence can allow the patient an ample opportunity to fully express their concerns.
Building trust requires more than just listening quietly, however. Another tactic to improve patient communication and trust is to use “active listening” to show you are paying attention to them. Use your body language to show you are engaged in what a patient has to say – leaning forward slightly, nodding your head along with points that you agree with, and making eye contact are all nonverbal cues that show a patient that you care and are listening. If you use a laptop or computer to take notes during a patient encounter, start the first few minutes of the encounter by setting the computer aside and allowing the patient time to speak with you directly, and ask the patient’s permission to use the computer to document information. This shows you are actively engaged in conversation with them – and not just ignoring them or being distracted by something on a screen.
After listening, be sure to summarize the patient’s concerns according to your understanding of the issues they are attempting to address. Statements like “Just so I am sure I understand…” or “It sounds as if you are telling me…” can help cut down on confusion in communication and make sure that all their concerns are being addressed. Once you have determined that you are on the same page as the patient, you can collaboratively address any areas of disagreement together and come up with a care plan that better suits their needs, which will build trust between you.
An organized, trustworthy environment
Building trust with patients extends to your physical and office environment as well. If a patient encounters friendly, professional, polite, and organized front office staff starting at check-in, they may implicitly trust the doctor when the time comes for their appointment. If you are in an office-based practice, having a clean and comfortable waiting area and patient rooms will go a long way toward instilling confidence in the care you provide. This approach can be another great, simple way to build trust in the doctor patient relationship.
During times of uncertainty and misinformation, building a trusting relationship with your patients is more important than ever. While challenges like social media, misinformation, and historical factors can all undermine trust, making a personal connection with patients can go a long way toward fostering a trusting relationship. Striving to listen actively to patient concerns, maintaining a professional demeanor on and offline, and ensuring a safe and comfortable atmosphere for patients in your work environment are all great ways to instill trust and confidence in your care for the patients you serve.