It was a sunny and cloudless September day, the weather still warm enough for T-shirts and shorts. Sitting by a round table decorated with poster board and flyers, I was providing mental health awareness and education at a health fair. The site was sandwiched between the bustling highways south of downtown Chicago and the Chicago River — the outskirts of Chinatown. All around me crowded small storefronts and narrow roads, a sharp contrast to the lake shore and skyscrapers of the wide Michigan Avenue.
“Hi,” I spoke to the elder woman approaching me.
Her few strands of gray hair waved as she supported her weight on a walker and slowly treaded toward my table.
“Has your mood changed recently?” I gently asked, “Have you, your friends or family lost interest in your hobbies or experienced low energy?”
She appeared to be caught off guard by my torpedo of personal questions and immediately responded, “No.” Realizing that I was a bit blunt, I changed my approach and began conversing with her about her daily routine, social life and family. She sensed my sincerity and confided that her relationship with her son was strained because of marriage and financial troubles, and the stress was causing sleeping problems and headaches. I was touched by her willingness to share her family problems with me, a complete stranger who happened to be wearing a white coat — the symbol of trust and service. I offered her a brief education about mental health, some general advice, as well as a list of services offered to Asian populations providing social support and community classes. Her eyes beamed with curiosity.
“Mrs. H, have you talked to your doctor about your distress and sleep problems?” I asked.
“Oh no, I don’t tell him that stuff. He’s busy and always rushing, and I don’t really trust him, anyway.”
Merely one month into medical school, I was enthusiastic to learn medicine and use my clinical skills to help people. Her remark about her physician, however, tainted my initial zeal.
Trust is the foundation of the patient-physician relationship and is formed through the physician’s crucial interactions with patients. Traditionally, many patients have placed a high level of trust in physicians, forming a paternalistic relationship. The nature of patient-physician relationships and the level of trust in physicians, however, have changed since more traditional time. Unfortunate events, such as the Tuskegee experiment or the story of Henrietta Lacks in the 1900s, have left a legacy of mistrust in the medical establishment and in physicians, and the mistrust still exists today.
The patient’s ability to trust his or her physician is heavily based on the physician’s competence, compassion, dependability, communication and transparency. Trust can reinforce the partnership by improving patients’ adherence to physicians’ treatment plans. Patients are more likely to follow up, change lifestyles and begin new treatments. Trust is the key to a healthy patient-physician relationship and will improve how medicine is delivered.
Dr. Leng, in her article on KevinMD, points out that communication style compatibility contributes to trust and relationship building. Communication encompasses interpersonal communication, mutual understanding, cultural competency and knowledge of the patient. Physicians are not only health care providers and educators, they are also the gateway to people’s understanding of their psychosocial and familial problems. With trust, respect and confidence, patients confide in physicians in ways few other professions experience. Patients and physicians are both benefactors of a trusting relationship. Physicians, armed with a holistic picture of their patients, can diagnose and treat patients effectively when communication and trust are upheld.
My preceptor, Dr. L, a well-respected physician in the area, has won the hearts of her patients, some of whom have admitted to being stubborn and skeptical about medicine at first. Every time I shadowed Dr. L, at least one of her patients would relay to me their stories of how Dr. L changed their health and their life by listening to their complaints. It is not unusual that Dr. L spends forty minutes with a patient or sees patients well past her work time. She patiently explains to her patients the basic anatomy and physiology involved in ailments, provides relevant scientific findings of a medication or treatment, and respects patients’ autonomy, all the while expressing urgency during treatment plan discussion. I am always amazed at Dr. L’s ability to form a bond of open communication and trust with her patients, and her example is one all can learn from.
Before the Mrs. H left, I told her my experiences as a patient: on one side was an urgent care physician with terrible bedside manners who interrupted me frequently, and the other side was my primary care doctor who genuinely and patiently listened to my complaints and concerns. The drastically different patient care styles fostered two very different forms of patient-physician relationship: I had full confidence and trust in my primary care physician while the urgent care doctor became a reminder for me to treat patients with respect. Mrs. H empathized with my experiences and expressed appreciation for sharing my story. In the end, I recommended her to openly communicate with her doctor and maybe even consider finding a different physician. Her expression changed — she now had a new goal and new hope. All thanks to a little communication and trust.