Suggestions for regaining patient trust

Neil Baum, MD

In the previous blog, I discussed the loss of trust in the American healthcare system following the pandemic of 2020-2022. In this blog, I will offer suggestions for regaining that trust.

I will focus on the lack of communication between patients and doctors which has been a source of mistrust in the medical profession.

Physicians often face pressure to see many patients quickly, leading to rushed doctor-patient interactions. This makes patients feel that their concerns are heard or addressed.

We sometimes use medical jargon without explaining the terms in layman's language. This can result in patients needing to understand their diagnosis, treatment options, or the implications of their condition. This further leads to clarity and trust.

Suppose patients perceive that their doctor is not empathetic or does not care about their concerns. In that case, it can diminish their trust in the doctor's ability to provide adequate care.

If we fail to provide information or explain the reasoning behind certain medical decisions, patients may feel excluded from making their own healthcare decisions. This can also lead to a sense of disempowerment and mistrust.

If doctors do not follow up with patients regarding test results, treatment progress, or ongoing care, patients may feel neglected. This can erode trust and even lead to litigation if the outcomes are less than what the patient expects.

Sometimes, patients have expectations about treatment outcomes that are not aligned with medical reality. Suppose these expectations are managed through clear communication. In that case, patients may become satisfied and confident when outcomes differ from anticipated.

Differences in language and cultural norms can further complicate communication, leading to misunderstandings and mistrust.

The American College of Chest Physicians recently suggested that doctors focus on the first five minutes of the doctor-patient encounter.

The First Five Minutes program consists of evidence-based skills to establish trust with your patients in the first five minutes of your interactions. Experience and patient feedback tell us that patients are more willing to follow medical instructions when they feel understood and have better long-term health outcomes. Getting to know your patients as soon as you enter the exam room and with the short time window is challenging. The First Five Minutes program helps establish a faster connection between doctor and patient and ensures trust in the physician.

It is an axiom that you don't get a second chance to make an excellent first impression. Therefore, it is very important to make a good first impression on the patient, and that occurs the moment the doctor opens the door to the exam room.

First, the patient makes an impression of the doctor before he opens his mouth and utters his first word. Patients expect us to look like a doctor. We create the aura of a physician with our appearance. Traditionally, this means wearing a white coat, a powerful symbol of being a physician. There's a difference between the doctor in jeans and sandals who has not shaved and the physician in a coat and tie without any five o'clock shadow at nine o'clock in the morning when we first start seeing patients. The best advice is to assume a dignified and conservative appearance, creating a favorable first impression in the first few seconds of the patient encounter.

You have a chance to create a favorable first impression through your smile and your demeanor. Your smile or the lack of a smile telegraphs to your patient an enormous amour about us. A smile indicates that you are receptive to listening and going to offer to help the patient. The mere turning up of the corners of our mouths can relax the patient and avoid making the patient tense, anxious, or worse, defensive. A smile makes the patient comfortable and ready to relate even the most intimate secrets they may not share with their partner, best friend, or clergy member. Remember that the words you say compromise only a small part of the message you convey to your patient, i.e., 7%. Your voice inflection delivers 28% of the message, and your body language, especially the smile and eye contact, sends the rest of the message. Thus, 65% of your message is non-verbal and depends on what you do in the first few seconds of your patient encounter.

Next is the first touch of the patient by the doctor. Upon entering the room, it is appropriate to use hand sanitizer in front of the patient and then shake the patient's hand. This is a subtle way of indicating good hygiene and a nice gesture to start the patient encounter. After all, touching patients has medicinal value, and tactfully doing so can be a lovely way to initiate the patient encounter and create trust between the doctor and the patient.

After the handshake, sitting down and being eyeball-to-eyeball with the patient is a good idea. If the doctor is standing and the patient is seated, you are creating the impression of superiority and not equality. It is far better to be at the same eye level as the patient, as this relaxes the patient and provides the impression that you are not in a hurry and that the patient has your undivided attention.

It is important to have good body language by sitting erect and leaning slightly forward. This conveys a receptive and active listening attitude by the physician.

Look the patient in the eye and avoid initiating the patient encounter by looking at the chart or the computer. Eye contact is vital to the communication process and looking directly at the patient and developing a physical connection is vital to creating trust.

Try to avoid having any barriers between the doctor and the patient. If possible, do not have an exam table, computer, or other physical structure between the doctor and the patient.

Open the dialog with the patient by asking non-medical questions. It is far better to start the patient encounter by asking them about their family, their work, or what book they were reading while waiting for the encounter to begin. It is far more critical to start with non-medical topics for a few seconds than by asking about their chief complaint.

Don't interrupt the patient. Interruption is a pervasive communication style with doctors. In a study by Beckman and Frankel pointed out that patients were allowed to complete their opening statement expressing their agenda in its entirety in only 23% of physician interviews. The average time to interruption was 18 seconds! If you want to make that first few seconds count, allow the patient to speak without interrupting them.

We also suggest asking new patients who referred them to the practice. It is a nice gesture to compliment the referring physician if you know the doctor or the referral source. If the patient states that they contacted the practice because of the website or the Internet, asking what words or names were used in the search engine is helpful. It is important to ensure that these keywords are used in the titles and body of your articles, blogs, and other social media.

Bottom Line: Improving communication between patients and doctors is crucial for building trust. When patients feel listened to, understood, and involved in their care, they are more likely to trust their healthcare providers and adhere to treatment plans.

Neil Baum is a physician in New Orleans and the author of The Business of Building and Managing a Healthcare Practice, Springer 2023