My next patient is 27 weeks pregnant and getting her diabetic screening test. I drag my feet a little heading to her room because I also have to have the dreaded vaccine talk. The patient is due for her Tdap vaccine, and with all the controversy regarding vaccines these days, I never know how it will go. Have I built enough trust with this patient to have a productive discussion, or will I face an uphill battle against skepticism and fear?
In every relationship, there are three entities: you, the other person and the space created in between. In obstetrics, I envision the epidural space, a potential space where medication is injected to manage pain. When building trust with patients, that potential space contains both me the doctor, the mother, the wife and the daughter as well as the patient with their various roles and experiences in life. What we create by mixing the two is shaped by the trust we build together.
Building Trust With Patients
So, how can we build trust with our patients?
Start With Self-Reflection and Empathy
First, we need to examine how we — as a physician or patient — are coming into the relationship. We all have implicit or unconscious biases, repeatedly imprinted on us by our family, our friends or the media. These biases affect how we interact with others and our capacity to build trust, as Academic Medicine notes. This isn’t about self-judgment; this is about being more conscious of and honest about how we present ourselves.
I grew up in a family of healthcare providers who believed in education, science and the value of vaccines. For my patient, this is her first pregnancy, the first time she’ll be making a decision about a vaccine for her child and possibly the first time she’s discussing this with a doctor. How can we bridge those gaps?
Make Time for Trust
Another element to aid in building trust with patients is time: time to speak, time to be heard, time to be seen, time to create a relationship. Patients have an increased level of trust if they think they’ve been given enough time to speak with their physicians.
However, many studies have looked at how quickly a patient is interrupted by their doctor — usually, it’s within 30 seconds. According to one study published in the Journal of General Internal Medicine, the median time was 11 seconds.
We’re all challenged with having enough time with patients, so it may be that we need to see how we can use the time we have more efficiently, which includes letting patients speak without interruptions. Perhaps for me, I need to allow my patient to first ask questions and discuss freely while pushing my agenda of convincing her she needs the vaccine to the backseat.
Share the Decision-Making Process
The idea of shared decision-making allows for a more interactive experience between patients and their physicians. It also includes a shared responsibility in medical management decisions, which helps to develop a more trusting relationship while helping patients navigate their healthcare. In addition, it reinforces that patients have choices and autonomy and that they understand their care plan and its ultimate goals.
Generally speaking, patients are more compliant with their care when they share in the decision-making process because they share ownership in their plan. By letting my patient know that it’s ultimately her choice while also providing her with accurate and reliable information about the vaccine, she now has ownership of her decision and, hopefully, trusts that I have her best interests in mind.
Inhabiting the Space of Trust
Before I open the door to the exam room, I take a breath, making room for me, for my patient and for the space in between. After I ask her how she is, I begin the vaccine conversation.
“Today we need to talk about the Tdap vaccine, which is recommended at the beginning of the third trimester of pregnancy. What do you know about the vaccine, and what questions do you have?”
With that, I hope I have entered our “relationship” space, where we can freely talk, sharing honestly and openly, the weaving of trust between us strong.