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Frank H. Boehm, MD
Prof. of Obstetrics and Gynecology,
Dir. of Maternal/Fetal Medicine,
Chairman of the Ethics Committee,
Vanderbilt University Medical Center
Trust is the glue that binds physician to patient and patient to physician. Having a trusting relationship is critical in a physician's ability to dispense good medical care. It is also a way to minimize malpractice claims.
At a time when the technologic element of medicine is ever increasing, when human touch is often replaced by machines and drugs, it is imperative for physicians to achieve and maintain a patient's trust. High tech demands more touch, not less. In a world with few if any house-calling family docotrs, it is critical for physicians to strive for this feeling of trust.
Communication and trust are closely intertwined. Medicine is in a crisis, and we need to address the issue of using communication to build trust.
The First Professionals Insurance Company recently noted that 82% of people who sue physicians cite communication issues as a major factor. Of this 82%, about a third of patients said that they perceived a lack of concern on the doctor's part, and another third highlighted the physician's failure to communicate.
Most patients who seek malpractice lawyers are motivated by perceptions of problems rather than by medical facts (JAMA 287[22]:2951-57, 2002). In this analysis, the investigators concluded that it was an inability of physicians to establish a rapport with their patients that was the primary cause of the increased risk of malpractice claims.
How do physicians build trust? Trust is not easily achieved and usually must be earned over a considerable period of time. Once, a white coat and a stethoscope brought instant trust and instilled instand confidence. Those days are gone. "Trust me, I'm a doctor," no longer works.
When a patient knows a little about his or her doctor, it allows for an increased sense of closeness; caring; and eventually, trust. Doctor and patient communication must flow both ways so that patients can begin to feel as if they understand and better know their doctor.
There are several ways for a physician to engage in and enhance this communication: casual conversation during office visits, sharing personal life experiences, or discussing important issues of the day. The more our patients know us as individuals, the more they will feel a sense of closeness to us, which will ultimately build trust. Other elements include where and how we sit during office and hospital visits, revealing our emotions verbally and nonverbally, writing condolence letters to patients' family, attending patients' funerals, and personally calling patients with test results or to just find out how they are doing.
Sharing some of my own life's experiences with my patients is one of the most important ways of helping them view me as an individual who faces the same issues and pressures of life as anyone else. This humanization process can open commnication and build trust. Physicians should know or be taught that it is acceptable to cry during emotional times.
It is appropriate and necessary sometimes to sit on the side of a patient's bed and hold her hand or put an arm around her in hopes of bringing support and comfort. People may forget exactly what you said or did, but they will never forget how you made them feel. When we generate a positive feeling in patients, we are on the way toward building trust.
It will not be enough for individual physicians to convince patients that they can be trusted. The medical profession as a whole must reveal to Americans that our entire profession can be trusted. We must show that our profession can help find a way for all citizens to receive expert medical care as well as compassion and respect. We must place a high priority on convincing Americans that they can trust us as individuals and as a group, to help remove the obstacles that now stand in the way of universal health coverage and care.
Through bidirectional communication, as well as being open in revealing our feelings and emotions, we can achieve a trusting relationship with our patients.
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