Trust: The Essential Ingredient In Patient Compliance

Trust: The Essential Ingredient In Patient Compliance

We trust you.  That’s the bottom line.  When we are sick and facing a serious life-threatening illness, we are open and vulnerable.  We can either follow your instructions or suffer the consequences.  Medical knowledge at the molecular level is not something we can just brush up on.  We can’t google our symptoms and come up with a successful treatment plan.  Explaining a cancer diagnosis or other serious life threatening illness to your patients in the same way that you would present it to a medical professional  would be as difficult as trying to explain calculus to someone who has not had academic math. In order for the treatment plan to work, trust has to be part the equation.

The backbone of any relationship, including the relationship we have with our physicians relies on trust.  Why?  Because we are afraid.  Afraid that maybe you don’t know what you are doing.  Afraid that because you are human, you will make a mistake.  You may still make a mistake, but if we trust you, then we are more willing to attribute it to a misstep that goes with the territory.  We patients are skittish creatures.  We don’t like handing the control of our bodies over to someone we barely know.

It is this kind of angst among patients that cultivates mistrust, and mistrust results from aberrant communication.  Without good communication, trust will not become part of the doctor-patient relationship.  You may be perfectly capable of doing your job without it, but as far as getting your patient to be compliant with your instructions, well—good luck.  You can say goodbye to getting good patient satisfaction scores, and hello to hospital administrators who are more than willing to start harassing you about it.

A prime example of using good communication skills to build trust can be found in the relationship that I have with my primary care physician. My first visit to him was when I was a young wife and mother, and he was in his first year of medical practice.   I liked him immediately.  He was open to questions and discussion, and if he didn’t know the answer to my question, he would excuse himself from the room to look it up.  Unfortunately, with the advent of computers being integrated into every household, I strayed a few times and sought medical advice from the unlicensed Dr. Google, but Dr. Black* took it in stride.  He did not scold me like a child or discourage my propensity for dabbling in his territory where I was ill equipped to correctly interpret the data, or for my occasional non-compliance in defiance of his instructions.  I often wondered why he never tired of my misguided inquires, and of my refusals to accept his opinion without question.  Sometimes, he was unable to hold back a deep inhalation or an escaped sigh, but for the most part, he was patient, and he listened until I finished presenting my angst ridden fears.

A few months ago, I heard on the evening news that proton-pump inhibitors were associated with dementia. Dr Black had prescribed them to me for GERD.  I stopped taking them, and at my next appointment, I told him so. “If you hear it on the evening news,” I explained, “then it has to be true.”  No yellow journalism there.  The evening news is not going to put something out there that isn’t true.

As usual, he sat quietly and listened to this disturbing information before speaking.  I have learned that this means a revelation is coming.  In a calm, unruffled manner, Dr. Black leans forward in his chair facing me and simply states, “Let me add my two cents.”

He wasn’t asking my permission. Dr. Black places his hands on the top of his desk spreading his fingers apart as if he is smoothing out a well-worn document. He explains that while there may be an association between proton-pump inhibitors and dementia, it doesn’t mean they have been subjected to the rigor of scientific study.

“An association can not be used to establish a cause and effect relationship,” he explains, and then, he leans in even closer as if he were about to reveal a well-kept medical secret.  “I can tell you with absolute certainty that there is a cause and effect relationship between GERD and esophageal cancer.”

Now it was my turn.  I didn’t reveal a thing.   I was still taking it all in, and it had a decidedly ominous feel to it. He did not ask me what I planned to do.  Upon arriving home, it didn’t take me more than a minute to run up the stairs, open the medicine cabinet, and swallow the proton-pump inhibitor that I should have taken earlier that morning.

“Did you forget to take your medicine?” My husband asked, as he hurried past me to get dressed for the afternoon shift at work.  I didn’t answer him. Once again, I had let my fears overrule common sense, but more importantly, I was busy contemplating something else.  Over the years, Dr. Black had polished and honed his communication skills with the precision of a surgeon.  Not one word too many, or none too few.  In addition, I had to acknowledge something even more extraordinary. I trust him.

*Psuedonym used to protect privacy.

Originally posted 2016-06-19 14:21:42. Republished by Blog Post Promoter

2 Responses to Trust: The Essential Ingredient In Patient Compliance

  1. Communication goes both ways. All the Dr. Blacks* do not listen. They assume. All to quick to whip out the prescription pad and add even more chemicals to the list already in the patient’s regimen. Sometimes it works okay but sometimes it isn’t thought out. Most of the time the additional drugs are beneficial. However, all too often the contraindications are not fully considered and/or communicated. “Does it build up in the system?” “How does it affect the ‘pill regimen’ already in place?” Well intentioned goes without saying. Our Dr. Black has helped more than hindered. There’s always room for improvement on both ends.

  2. I’ve never looked at it as a trust issue before, but you’re absolutely right. I can’t tell you how many prescriptions I’ve tossed after “Dr. Google” assured me they were unnecessary. My provider is a really nice guy, but I don’t trust him. I’ve heard him give the same advice word for word to other patients (the office walls are thin). It’s like he has a script. Thanks for the wake up call. “Nice” doesn’t always mean “Effective” when it comes to healthcare.