By Matthew C. Popkin, M.D.
Founder, President and Chief Medical Officer at i-Medical Consulting.
Going to the doctor can be a frightening experience for many people and as such some may avoid telling the doctor the things that are necessary to make an accurate diagnosis and prescribe the proper treatment. Even worse, this fear of going to the doctor often makes a person rationalize away their symptoms as unimportant so they don’t seek out help or go to the doctor at all. The element that can overcome this fear is trust. Trust in yourself that you can recognize the signs your body and mind are telling you that you need to seek help. Trust in your physician that he or she will listen to you and care enough to give you the time to fully explain your symptoms so a proper diagnosis and treatment can made.
Trust in your ability to become engaged as an active participant in your medical care so you can maintain health and wellness.
Recent studies have shown that even though only 23% of Americans have confidence in the health care system, more than two-thirds (69%) trust their doctors’ honesty and integrity. Trusting that your doctor will deliver ethical healthcare that is best suited to your particular health needs is a must-have in a healthy doctor-patient relationship.
Trust is one of the most important and intangible parts of any relationship and the doctor-patient relationship is no exception. The element of trust is necessary on both sides of this relationship. It is this mutual trust that will help build a relationship that works to keep you healthy. So let’s define this relationship. As stated by S.D. Goold in 1999 “the doctor-patient relationship is remarkable for its centrality during life-altering and meaningful times in persons’ lives, times of birth, death, severe illness and healing. Thus, providing healthcare, and being a doctor, is a moral enterprise.” In my opinion, the physician’s outward display of morality as seen in how they practice medicine is what allows trust to form in the heart and soul of the patient.
It has been proven that a good doctor-patient relationship can improve health outcomes, so it’s worth investing the effort to develop trust in your physician.
Trust can take time and possibly several appointments to develop with a new doctor or one you’ve been seeing for a while. The path to developing trust with your physician involves many factors. I feel that communication and empathy are the most important and at the same time the most underappreciated factors to consider. Let’s explore how communication and empathy are the keys to developing trust in the relationship with your doctor.
Communication is a two-way street:
Appropriate diagnosis and treatment of an illness depend on your ability to communicate your symptoms and concerns, along with your physician’s ability to listen. If your physician doesn’t listen, you may feel like they are not interested in your condition which in turn may make you say less. The result could be that your doctor ends up making an uninformed decision about your treatment plan.
One of the biggest complaints patients have is feeling that they are not being heard. If a physician doesn’t take the time to listen to their patient they won’t fully understand what is happening. Not only will the physician’s ability to care for their patient be compromised, but also a great opportunity for developing a trusting and meaningful relationship will be lost.
Likewise, your ability to trust the signs and symptoms your body is telling you and effectively communicate this information to your physician is vital. You must also trust your physician’s translation of complex medical information into an understandable and effective treatment plan. On both sides, if communication skills are lacking, the relationship suffers.
Physician empathy:
Empathy is the art of seeing the world as someone else sees it. It is the ability to share another person’s’ perspective, to stand in their shoes mentally and see the world from their point of view. Empathy allows a physician to understand what a patient is feeling. Empathy helps physicians communicate their thoughts in a way that makes sense to the patient, and it helps the physician understand what the patient is communicating to them. In the doctor-patient relationship listening simply isn’t enough. The doctor who fully understands the patient’s perspective is better able to build trust and provide treatment plans that match the patient’s needs. Empathy is a valuable part of the doctor-patient bond which allows us as physicians to understand both the physical ailment the patient is suffering from as well as the emotional component which is equally important. The ability to empathize is one of the most important qualities a physician can share with their patient and helps gain their trust to achieve a mutually beneficial relationship. So how does a physician get empathy? How do we understand what a patient is feeling? As I said earlier, empathy is an art. It is a valuable component to practicing the art of medicine. It is therefore vital for the patient to find a physician that truly has an interest in understanding how they feel, not just understanding what the lab tests show or what medicines to prescribe. Empathy, like trust is one of the most important and intangible parts of any doctor-patient relationship and should not be overlooked.
Developing trust depends on many factors, not the least of which is the ability to maintain a strong, healthy relationship with your doctor. The ability to connect with and trust your physician may be just as important as their education, background, office location or what insurances they accept.
Now that we established how important trust is in this relationship, let’s see how this trust helps overcome the obstacles that can hinder the delivery of quality medical care.
Trust overcomes fear:
Fear of bad news from the doctor is something that can prevent a patient from reaching out for help entirely or fear can make a patient provide inaccurate information or withhold information from the doctor to avoid getting bad news about an illness. This fear of seeking help or telling all the facts to the doctor only delays the proper diagnosis and treatment. You run the risk of trading bad news now for worse news later. A delay in diagnosis makes treatment much harder and usually leads to worse outcomes. The alternative is to trust yourself and your doctor to overcome these fears to get the proper help you need.
Trust overcomes anxiety:
Patients that have anxiety over a possible illness need to discuss this anxiety with their doctor to prevent it from slowing the path to the proper diagnosis and treatment. Trust yourself to not rationalize away the signs your body is telling you due to fear and anxiety. Trust your physician enough to communicate to them that you have anxiety related to your illness. This will invoke empathy on the part of the physician who will put you at ease and assure you that you are not the first person with these symptoms and they will do everything they can to help you. This will ensure that the lines of communication stay open and will help you get the proper care you need.
Trust overcomes embarrassment:
Often patients are embarrassed to discuss certain problems with their doctor out of fear of judgment or ridicule. This almost always leads to a delay in diagnosis with often severe or fatal consequences. Case in point, patients with psychiatric illness feel shame and embarrassment mostly due to a lack of understanding of mental illness by many people in the community. This leads to silent suffering and worsening mental illness as evidenced by the epidemic we have in our country today, veteran suicide. According to the most recent report published by the Department of Veterans Affairs, 20 veterans died each day by suicide in 2014. This report spanned a time period from 1979 to 2014. If you multiply the suicide rate of 20 veterans per day over the 35 year time period that means that 255,500 of our nation’s veterans have died by suicide over the past 35 years. That is 44,190 more veteran suicide deaths than the total wartime deaths from World War 1, Korea and Vietnam combined (211,310 deaths) if you use the statistics reported by the American War and Military Operations Casualties: Lists and Statistics dated February 26, 2010. Even though those wars are over our veterans continue to suffer silently and struggle with suicide at an alarming rate to this day. Countless other veterans that don’t commit suicide suffer daily with mental illness and this number is even more staggering. According to a 2014 report published by the Institute for Medicine, between 2000 and 2011 nearly 1 million veterans were diagnosed with at least one psychological disorder and almost half had multiple disorders. Only about half of these veterans receive the recommended therapy they need. This needs to be addressed. The lack of understanding, and empathy, on the part of many people creates a perceived stigma that leads to the embarrassment that causes people with mental illness not to reach out for help. This public perception should not be mistaken for a lack of understanding and empathy in the medical community. We need proper education and public awareness to remove this perceived stigma and change the mindset that mental illness is different from any other illness that needs proper diagnosis and treatment. Improved awareness will bridge the gap between our veterans’ suffering and the care they so desperately need and deserve. We must remove any barriers in delivering proper mental health treatment. People need to trust in themselves and the medical community to reach out for help when they are in need to end their silent suffering.
Trust overcomes the fear of loss of privacy:
You must trust that what you say to your doctor is private and protected information. The Health Insurance Portability and Accountability Act (HIPPA) laws ensure that. Withholding information from your physician out of fear that someone else will use this information against you is unnecessary and will only serve to slow down the diagnostic process. The information you discuss with your doctor is private and only used to help make the most appropriate treatment plan possible. You should trust that your doctor has very strict policies and procedures in place to make you comfortable in fully disclosing your medical condition so as to avoid leaving out information that could delay proper medical care.
Trust overcomes uncertainty:
Patients should trust that they can say anything or ask their doctor any questions they may have. As the saying goes, “there are no stupid questions, only stupid answers.” Patients have to realize that they need to be an active participant in their health care in order for the medical system to be effective. Patients need to be engaged in the process and learn as much as they can on how they can participate in the treatment plan. They need to trust that their doctor will appreciate this level of interest and participation and take any information the patient presents under careful consideration as this information is coming from a trusted source, their patient.
In conclusion:
Trust is essential for establishing, maintaining and strengthening the doctor-patient relationship. Communication and empathy are the keys to developing this trust. Trust is important to this relationship because it helps overcome the fear, anxiety, embarrassment, privacy concerns and uncertainty that people feel when they are sick. Removing these barriers between the doctor and the patient will lead to a more positive experience and better treatment outcomes.
Your health and wellness are of prime importance and as such you should trust in yourself to recognize the signs your body is giving you. You must trust your physician enough to reach out for help during times of need. You must both have a mutual trust in each other that will help develop the doctor-patient relationship that will ultimately maintain your overall health and wellness throughout your lifetime. This precious relationship should be built on a solid foundation of trust.