The Doctor–Patient Relationship: Trust Needs to Go Both Ways

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Most people would agree that trust is an essential component of any effective doctor-patient relationship. Although we often hear about the importance of patients trusting their doctors, seldom do we hear much about the need for doctors to trust their patients.

An article published on March 22, 2019 in the Journal of the American Medical Association (JAMA) addresses this lopsided focus and encourages physicians to actively cultivate a reciprocal trust relationship with their patients.

The article points out that in the past, the measure of a doctor’s ability to trust a patient was based on the patient:

  • providing accurate information
  • answering questions honestly
  • adhering to physician guidance
  • not trying to manipulate the physician for personal gain (such as trying to get excessive pain medication)
  • respecting the physician’s time and personal boundaries

Now, however, the authors say, “…the principles underlying the patient-physician relationship must shift from simply emphasizing patients’ adherence to cultivating patients’ ability to contribute to the development of care plans that reflect their own values and preferences.”

Communication Builds Trust

Patient surveys repeatedly show that one of the main things patients want in their relationship with their doctor is good communication. As patients, we’re much more likely to trust our doctor if we feel like he is listening to us and values our input.

Unfortunately, if a recent study is any indication, listening is something many doctors do not do very well. The study, published in the January 2019 issue of the Journal of General Internal Medicine, found that doctors averaged only 11 seconds before interrupting their patients’ opening statements.

The JAMA article reminds physicians that patients are experts when it comes to their own experiences, and listening to their narratives can have significant value in making an accurate diagnosis. Some ways doctors can show that they’re listening to their patients include: making eye contact, not interrupting them and asking questions based on what the patient has told them.

5 Tips to Improve Doctor-Patient Communication

Of course, trust in a doctor-patient relationship needs to go both ways. As a patient, you can’t force your doctor to trust you, but there are things you can do to improve communication, which will help to begin building a mutually trusting relationship.

  1. Come prepared. Let your doctor know you value her time by bringing a written list of the symptoms and concerns you want to discuss.
  2. Worst goes first. Start with what is bothering or concerning you the most. Your doctor will start forming a diagnostic opinion early on based on what you’re saying, so don’t save your key concerns until the end.
  3. Don’t minimize your symptoms. If you minimize your symptoms by saying something like, “It’s just a little headache,” your doctor may not take it very seriously. If what you’re really worried about is that you might be developing severe migraines like your mother had, let your doctor know your concerns.
  4. Be honest and upfront. Let your doctor know what medications and supplements your taking as well as any complementary or alternative therapies you’ve tried and whether or not they have helped. Also be upfront about personal and lifestyle habits. Hiding such information can hinder getting an accurate diagnosis and effective treatment.
  5. Ask questions. Let your doctor know you are listening and want to follow his instructions by asking questions to clarify or repeating back what he said to make sure you heard it correctly. You can also use questions to help ensure that your doctor is really hearing you. For example, you might ask, “Should I be concerned about this?” or “What do you think might be causing this?”

Patient Participation in Treatment Is Essential

In addition to improving diagnostic accuracy, the JAMA article also points out the importance of patient participation and mutual trust when it comes to developing a treatment plan. The personal beliefs, values, preferences and goals of patients must be taken into consideration. After all, a patient is much more likely to adhere to a treatment regimen if they have been included in the decision and are comfortable with the plan.

This is especially important when working with patients who have a chronic illness like fibromyalgia. Treating fibromyalgia is never a simple matter. At best, it is a long, slow process of trial and error. Fibromyalgia treatment plans generally need to be multi-faceted and include a variety of modalities, including: prescription medications, supplements, exercise, diet, lifestyle changes and body-work therapies like massage and acupuncture.

It’s essential for the doctor and patient to communicate openly and clearly with one another in order to maximize the chances of a treatment plan being effective. Both parties need to communicate their expectations and agree on goals. Patients should feel free to share what they experienced when trying various treatments––such as, side effects from medications, improvements from dietary changes or increased pain from a particular exercise––so their doctor can adjust their treatment plan accordingly to meet their individual needs.

Healing Is a Team Effort

The authors of the JAMA article concluded by saying, “When physicians stop simply seeking patients’ adherence to their proposed care plans and instead work with patients toward a co-created strategy that reflects each patient’s beliefs, values, preferences, and abilities, the groundwork for mutual trust is effectively laid and healing can begin.

Well said.


Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) in 1997 and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE magazine. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, then worked for eight years as the Chronic Pain Health Guide for The HealthCentral Network before coming to ProHealth. To learn more about Karen, see “Meet Karen Lee Richards.”


Resources:

Grob R, Darien G, Meyers D. Why physicians should trust in patients. JAMA. 2019;321(14):1347-1348. doi:10.1001/jama.2019.1500.

Ospina NS, Phillips KA, Rodriguez-Gutlerrez R, et al. Eliciting the patient’s agenda – Secondary analysis of recorded clinical encounters. J Gen Intern Med. 2019 Jan;34(1):36-40. doi: 10.1007/s11606-018-4540-5.

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