Medical advancements and life-improving/lifesaving tools have rapidly evolved over the past several decades. Yet, trust in healthcare and healthcare institutions has been declining during that same period and has only been exacerbated recently by the COVID-19 pandemic. Medicine and science related to healthcare have become so complex that many areas of medicine are truly only understood by a select group of sub-specialists, and many have lost the big picture when it comes to an individual’s health and become stuck in the weeds. The tools and skills required to effectively communicate science and medicine are lacking, especially in a world in which medical complexity is rising while time and individuals’ attention are at a premium.
Furthermore, lack of trust in medicine is compounded by an opaque and exceptionally complex system that often leaves patients at a loss or without their needs fully addressed. Most people today, even those who are highly educated, have relatively low health literacy and, moreover, have a very limited understanding of what physicians do and the training and sacrifice needed to achieve a master of medicine and the human body. Let’s explore an example.
Listening & Finding Common Ground
Mr. L is 63-year-old patient for whom I have cared for many years. He has multiple chronic medical problems that include spinal stenosis and some radicular symptoms resulting in drop foot and chronic pain. His wife is a former nurse who quit the profession 25 years ago. Mr. L has had several surgeries and procedures, none of which have helped his pain or foot drop, and he struggles with mobility, chronic pain, and barriers to obtain mobility equipment. He pays a large portion of this limited income on medications, copays, and stays at several hospitalizations that were out of network, thus incurring a significant amount of medical debt. He obtains his news and information from a select few sources and family members, with partial or simply inaccurate health information that I might describe as dubious at best.
One morning, at the end of our visit, I recommended he receive his flu vaccine since he is at high risk of complication if he were to contract influenza. He looked at me in disgust and said, “I trust you doc, but I don’t trust those drug companies.” This is a patient who has every reason to distrust medicine and healthcare in general, given all he has been through, and I cannot blame him for his mistrust. I sat and listened to his concerns, anxiously as the green icons on my computer screen indicated my next two patients were ready and waiting for me. I did not try to tell him why his information was incorrect or throw out statistics or data to support my recommendation. I just listened and tried to better understand his concerns. I shared some of my personal and professional experience treating patients with influenza who had not been vaccinated. I looked for a way to leverage our individual relationship and personal trust we had built to help improve or preserve his health. Through the longitudinal relationship and trust that Mr. L and I had built, we were able find common ground, and although he did not accept his flu shot that day, or the next visit, he did eventually accept it at a subsequent visit and after multiple conversations.
Studies have shown that an individual’s own physician, and moreover their primary care physician, is perhaps the most trusted messenger when it comes to health information and health decisions; the reason for this is the longitudinal relationship and trust that has been built over time. A physician taking the time to get to know their patient and see them as an individual can have a tremendous impact on the patient’s willingness and ability to trust in the physician, as well as the information the physician provides. However, this takes time and will not happen all at once. Taking a moment to ask an individual how their family is doing or how things are at work can take just a moment but can have a tremendous impact, showing a patient that their physician cares and sees them as an individual. Similarly, if trust and understanding has been established, a brief comment like, “I highly recommend you get your flu vaccine to protect you and your family this winter” at the end of the visit can be deeply impactful.
We Have Work to Do
To help the public better understand what we do and the rigorous journey to becoming a physician, we need to do a better job communicating with patients both individually and collectively through traditional media, op-eds, and social media. We must not only communicate what we do, but why we do it! We didn’t go into medicine to get rich or make a quick buck, and our patients and the public need to better understand the sacrifices and academic process we went, and continue to go through, to ensure that we are equipped to counsel and educate them. Simply repeating the latest sound bite won’t cut it.
We have work to do, and all physicians need to lean in and send a few extra moments with each patient or provide some insight into how medicine works and the central role that physicians must play to improve the health of our patients, community, and nation.