Hardly a week goes by without hearing about another case of police brutality. Many times, seemingly unnecessarily lethal force has been used. These incidents have sparked protests across America. Each case is unique with differentiating circumstances, but the end result is all too often, death. Many people have grouped these incidents together concluding that white officers have unnecessarily killed black men. This has initiated and reinforced mistrust of the entire police force in many communities. Realistically, the majority of the police force is here to protect and to serve. Nonetheless, in many communities, this trust has eroded and left many with the perception that the police force is simply out to violate the rights of racial, ethnic and religious minorities. For others, images of police dogs and fire hoses of the 60’s have been reinforced exclaiming no change. Perceptions move quickly from interpersonal mistrust to institutional mistrust.
For healthcare providers, both types of mistrust can serve as a reminder that we too are subject to the scrutiny of the public. Each of our patients approaches us from a different perspective via various walks of life. Although, the vast majority of our profession has very altruistic values while preventing disease and treating illness, episodes of our collective past may negate those values. Malicious medical experimentation including The Tuskegee Experiment or prisoners in Nazi Germany coupled with physicians who publish fictitious research about vaccines and autism could easily provoke mistrust institutionally.
Trust does not necessarily come automatically with the patient-provider relationship; it may need to be earned. This is often accomplished with taking a little time to know your patient while being friendly, courteous, empathetic and kind. Conversely, we are often pressed for time as our schedules seemingly don’t allow for idle conversation, eye contact, or even a handshake while grappling with a computer.
Scientifically measuring trust has proven to be quite difficult (1). Some even posit that trust increases patient satisfaction, reduces health care disparities, and improves outcomes with better adherence to treatment plans (2). Meanwhile, trust is perceived from both the provider and the patient perspective. A factor playing into our own prescriptive treatment is affected by our trust within our patients. This would be all much simpler with classes in medical school about building trusting relationships (ideally it would be placed between the cardiovascular and neurology section). Even though great interventions to influence trust have not been developed(3), many of us have developed a myriad of trusting relationships with our patients over the years. These relationships are unlikely coincidental. When trust is optimal, the experience of the visit tends to be positive whether patient or provider.
As healthcare providers go about their daily routine, we must be mindful of a patient’s thoughts while being introspective of our own. When an encounter is suboptimal, consider trust as an underlying factor. It may take time to build our individual trust particularly in light of institutional mistrust(4). If a trusting relationship is achieved, it will be stronger with medical literature purporting better outcomes.
After all, we physicians take a privileged part in people’s lives; we must establish trust.
References:
(1) Lee Y, Lin JL; Linking Patients’ Trust in Physicians to Health Outcomes; B J Hosp Med; Jan2008; 69(1) 42-46
(2) Nguyen GC et al. Patient Trust-in-Physician and Race Are Predictors of Adherence to Medical Management in Inflammatory Bowel Disease; IBD; Jan 2009; 15(8) ;1233-1239
(3) Rolfe A; Interventions for Improving Patients’ Trust in Doctors and Groups of Doctors; Cochran Database Syst Rev; 01Jan2014; 3:CD004134
(4) Simonds VW et al; Cultural Identity and Patient Trust Among Older American Indians; J Gen Intern Med; 01MAR2014; 29(3) 500-506
