Monday, September 30, 2024

Suggestions for regaining patient trust

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.

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Friday, September 27, 2024

Do your patients understand what you are telling them?

Lack of patient engagement, including poor adherence to treatment plans, medications, and appointments, is a key pain point for many physicians. If you’ve been practicing medicine for a while, you know that patient engagement is one of the main factors that can make or break a patient’s health journey.

Contributing to this lack of patient engagement is poor health literacy (i.e. when patients lack the information, context, or perspective necessary to make optimal health care choices). Unfortunately, according to the National Library of Medicine, a staggering 9 out of 10 adults struggle with health literacy.

Indeed, without effective engagement with their physicians, patients may not follow through on key actions in between doctor visits. Therefore, this health literacy deficit directly drives poor engagement and the subsequent worsening of health outcomes over time. In fact, research shows that health literacy can be a more important predictor of health than race, socioeconomic status, or educational attainment.

So, how can physicians begin to tackle health literacy?

Bridging this health literacy gap is not trivial. More educational materials or just spending more time with each patient is not enough. The problem is deeper and broader, thus the solution needs to similarly be more encompassing.



Social health + health literacy connection


Poor health literacy creates a ‘social’ distance between us and our patients. Maybe you’ve experienced this? The feeling of being in a foreign country where you do not speak the language. You may be surrounded by people, but because of your illiteracy, you would still be lost.

In this same vein, even patients who come to visit their physician regularly may not have the tools or background knowledge necessary to understand their care plan. When patients cannot fully grasp what we are sharing – education about their condition, their medication regimen, etc. – this can lead patients to feel inadequate, confused, and even threatened.

This distance contributes to the perverse feeling of ‘loneliness’, which, as we know, is already pervasive among our most vulnerable, elderly, and marginalized patients.

For this reason, we need to check for patient understanding during the visit and follow through after the visit. Importantly, patients often need people in their lives who can help them better process important medical decisions, understand the lifestyle changes they need to make, and then support them in developing those healthy habits to better self-manage their chronic conditions. In addition, these critical people can assist patients in advocating for themselves at the pharmacy, asking the right questions about their chronic condition, reminding them to take their medications at home, or even helping them get to their appointments. This can be anyone who the patient trusts: a relative, a neighbor, a friend, or a peer mentor. Developing these connections can help improve social health.

What is social health? It’s the complete network of connections a patient has with their family, community, physicians, health plans, pharmacies, etc. These supportive connections help increase health literacy, improve health, and build resiliency to withstand future challenges to one’s health. These connections can also help overcome barriers related to the social determinants of health (SDoH), as well as help to ‘translate’ complex medical concepts into both knowledge and then action. These connections can help the patient connect the often siloed parts of our health system.



How can physicians help?


There are many ways that physicians can help improve health literacy: sharing success habits between patients, checking for understanding, and highlighting the importance of social health are a few great places to start.

Sharing success habits: Begin identifying patients who successfully follow through on their care plans and explore the reasons behind their success. To do this, physicians can integrate these discussions about successful adherence and lifestyle changes into their practice by having nurses or medical assistants play a role. Then, during the latter part of the appointment, the physician can delve deeper into what specific factors contributed to positive changes in diet, exercise, or medication adherence. Understanding what motivated these patients can provide valuable insights to share with other patients who are in a similar boat, but still struggling.

Checking for understanding (in the office):Incorporating “teachbacks” can also be a great way to gauge if a patient fully understands what was shared. Research shows that asking a patient to explain back to you their condition, or how they think their medication works, can increase knowledge retention, reduce hospital admissions, and even improve patient satisfaction. Teachbacks take time but can be incorporated into not just the physician’s workflow, but also the workflow of nurses and MAs. Interestingly, these are often win-win. Ideally, the patient expresses full understanding, but if they do not – it’s an opportunity to remediate with that patient before they leave the office. And, perhaps even more important, this can provide critical feedback to the physician on how they can better teach all future patients.

Checking for understanding and action (out of the office):Physicians’ offices should also engage with patients outside of their regular appointment times, too. Oftentimes, patients don't realize they lack understanding until they attempt to follow their treatment plan at home. Connecting patients with peer mentors can be one way to help answer those in-the-moment questions between appointments. Online resources can also provide helpful context at home. In addition, physicians can emphasize the importance of the patient engaging their family, friends, and community in their health. Building these social connections can build a helpful personal support network with immediate and far-reaching benefits. Helping patients build social health can reduce health literacy, and pave the pathway toward better health.

Tackling poor health literacy takes a village -- a lot of time, energy, and effort. However, it’s worth it since the benefits to one patient end up accruing to the entire village! By building mutual trust and respect with patients, doctors can help them feel more comfortable, better understand their care plans, and ultimately achieve better health outcomes – a win-win for everyone involved.

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Wednesday, September 25, 2024

Loss of patients’ trust after the pandemic

I have had discussions with physicians and patients, and both conclude that trust has been eroded in the healthcare system. When I started my career as a physician forty-five years ago, the doctor was held on a pedestal and had the admiration of our patients and the public as well. I have noticed that our patients' trust decline began after the COVID-19 pandemic. This erosion can be attributed to several factors, including communication challenges, misinformation, and systemic issues.

First, there is a proliferation of misinformation, particularly on social media, which exploded after the pandemic. During the pandemic, conflicting messages about treatments, vaccines, and the virus itself led to confusion and mistrust among the public. Patients felt that physicians were either not fully informed or even misinformed where the virus originated.

There were organized efforts to spread false information, sometimes driven by political or financial motives, which further eroded trust in the entire healthcare system. Some patients began questioning the integrity and honesty of medical professionals who endorsed public health measures or vaccines.

As scientific understanding of COVID-19 evolved, public health guidelines and medical advice also changed. While this is a natural part of medical progress, the frequent changes in the advice we gave our patients were perceived as inconsistency or incompetence, ultimately leading to skepticism.

Health organizations, government bodies, and even individual doctors sometimes give conflicting advice. This lack of a unified message undermines public confidence and leads to a loss of trust in medical professionals.

The pandemic became highly politicized, with public health measures like mask-wearing and vaccination becoming divisive. Physicians who advocated for these measures were sometimes viewed as biased, leading some patients to distrust the physician's motives.

In some cases, physicians were pressured to align with political viewpoints, which could lead to the perception that they were not acting independently or in the best interest of their patients.

The healthcare systems became overwhelmed, and there were shortages of medical supplies, such as a decrease in the supply of N95 masks and personal protective equipment (PPE). Then, there was a slow rollout of vaccines, which contributed to a perception of failure of the entire healthcare system. Individual physicians were sometimes blamed for issues that were beyond their control.

The pandemic also exacerbated existing health disparities. Some communities, particularly those of lower socioeconomic status or minority groups, felt neglected or mistreated by the healthcare system, leading to a greater distrust of medical professionals.

The pandemic took a significant toll on mental health, with many patients feeling isolated, anxious, and stressed. In some cases, patients felt that their emotional and psychological needs were not adequately addressed by physicians, leading to feelings of neglect or dissatisfaction. Physicians also experienced hardships and mental health issues. This was illuminated on April 16, 2020, when an emergency room physician, Dr. Lorna Breen, took her own life because of exhaustion caring for COVID patients.

The economic strain caused by the pandemic, including job losses and costly medical bills, increased patients' frustration, and resentment of the healthcare system. Some saw the healthcare industry, including physicians, as profit-driven rather than patient-focused.

The shift to telemedicine during and after the pandemic sometimes led to a less personal connection between patients and physicians. The lack of in-person interaction made building and maintaining trust more challenging.

Many physicians were overworked and overwhelmed during the pandemic, which could have led to less effective communication and a perceived lack of empathy, further eroding trust.

Bottom Line: The loss of trust in physicians during and following the COVID-19 pandemic is a complex issue rooted in the intersection of misinformation, inconsistent messaging, political polarization, systemic healthcare failures, and communication challenges. Rebuilding this trust requires efforts from both individual physicians and the entire healthcare system. In the next blog, I will discuss suggestions for rebuilding the trust we enjoyed before the pandemic.

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