Building Patient Trust In and Out of the Office

“The physician-patient relationship has taken a major hit over the years and the connection is much less than it used to be. We have to reimagine the relationship. It has to evolve because the current relationship isn’t working.”

~ Andrew Morris-Singer, MD

Internist and President of Primary Care Progress (An organization working to improve primary care)

At one time, the vast majority of patients said they placed complete trust in their medical providers. But that trust then began to decline, as evidenced by the above quote which appeared in Medical Economics on April 10, 2018, and that was way before COVID hit! Thanks to conspiracy theories, rampant misinformation, and instant press or social media analysis of every medical announcement, it has become harder and harder for doctors to build trust with their patients.

But, trust is a crucial factor in every relationship — friends, families, co-workers, and partners — we trust other people to do what is right. Nowhere is trust more important, though, than in the medical relationship, where a lack of trust can have truly life-altering consequences:

• Patients may not follow their doctor’s treatment plan, leading to poorer outcomes or further complications.
• Patients could second-guess their doctor by researching medication information on their own, without thinking about possible side effects or contra-indications.
• Self-prescribed treatments could hamper the results that would be achieved with full adherence to the doctor’s treatment plan.
• Patients may withhold critical information about their condition, or skip appointments, preventing the doctor from obtaining full information.
• Chronic care patients who do not follow their doctors’ advice could make their condition worse and threaten their own ability to maintain an acceptable quality of life.

The decrease in trust also affects physicians negatively. Those who went into the field for the noblest of reasons may now feel that their actions have no meaning. They begin to experience stress and burnout. When added to stress associated with administrative tasks, lost revenue due to the pandemic, and constant arguments over reimbursement and payment issues, it is no wonder that many independent practices have closed.

Why Trust Matters in the Physician-Patient Relationship

“Physicians and patients need to work together to pursue care that improves health,
avoids harm, and eliminates wasteful practices”

~ Dr. Amir Qaseem

It may be difficult to pinpoint any one factor as to why trust has been eroding, but the increased focus on revenue may certainly contribute to the decline. To save time, doctors may feel compelled to shorten patient visits, chart as they talk, or refer patients to other members of their team – all of which may seem reasonable in the attempt to maximize revenue but is seen as a negative in patients’ eyes.

What the patients really want is time to build a relationship with their healthcare provider. They need to feel they have been heard and understood. Repeated successful interactions can lead to an increase in trust, but that is hard to achieve when time is in such short supply.

Trust can take a long time to build, and a short time to erode. Unfortunately, patients who don’t trust their medical professionals may also be prone to lying. A 2018 study showed that 60 to 80 percent of patients surveyed said they were not forthcoming about relevant information, or even lied outright to their physicians. Some “little fibs” or “understatements,” especially pertaining to exercise, alcohol or smoking habits, could negatively affect the course of treatment. Reasons for withholding information included:

• Fear concerning what the truth may reveal about their health.
• Embarrassment about the condition.
• Fear of admitting they have not followed the doctor’s orders.
• Not wanting to feel judged.
• Don’t want to receive a lecture.
• Fear of unflattering information being permanently included in their medical record.
• Not wanting spouse or family members to know.
• Concern about wasting the provider’s time/feeling that the provider is in too much of a rush.
• Thinking the issue was not important.
• Being concerned that the information would cause the provider not to like them.
• Disagreement with the physician’s recommendations.
• Misunderstanding the question or instructions.

This reluctance to trust and share completely regrettably means the medical provider can’t accurately assess symptoms and diagnose their cause. This could lead to additional testing, improper medication dosages, and an inaccurate diagnosis. In the worst-case scenario, patients may avoid returning to the office altogether, putting their health at extreme risk.

Conversely, patients who do trust their doctors are more likely to share information and follow the prescribed course of treatment. For patients with chronic care or long-term health conditions, trust can lead to fewer trips to the emergency room or stays in the hospital.

Becoming a Partner in Health

“Today’s patients are savvy healthcare consumers seeking access to trusted healthcare content and digital health technology that empowers them to make educated care decisions throughout their health and wellness journey.”

~ Physicians Practice, July 2021

As patients become more engaged in their own healthcare, they may also become more wary of blindly following their doctors’ directives. As a practitioner, you can counter this suspicion by explaining to patients the rationale you use for making treatment recommendations, offer potential alternatives, and share the decision-making process.

Physicians Practice featured the above quote in an informative article on how to strengthen care by building authentic partnerships. The article recommends building trust at every touchpoint, providing consistent information, and responding to the patient’s emotional needs. Increased use of modern-day technology may help to ease this process, but the five basic steps your independent practice can take to help patients make better care choices include:

• Educate: The article heavily recommends investing in patient education across the enterprise by providing information and materials that explain medications and procedures, to help patients understand their condition, available treatment options, and negatives of non-compliance.
• Engage: This step is designed to motivate patients to take a role in their own healthcare by deepening their understanding. This may require a transition to different types of communication forums and educational media.
• Activate: As patients become more engaged, they are likely to become more active in the care process by participating in preventative care and wellness activities. They may become more likely to share information and engage in wellness screenings.
• Coach: Instead of directing, the physician serves more as a coach who is facilitating the transition to patient-centered care. The coach helps the patient understand the importance of a healthier lifestyle and provides guidance to wellness activities. Examples of coaching may be seen in remote patient monitoring situations where a trained medical professional analyzes data, and then coaches the patient to maintain current activity levels or make changes to improve results.
• Partner: Every touchpoint is seen as an opportunity to improve the physician-patient partnership. Patients become actively involved in taking steps to improve health outcomes, while physicians can once again feel the joy of healing.

How to Build Relationships by Building Trust

The fact that they do agree to visit a doctor indicates that patients have at least a minimal interest in improving their own health. The challenge for the independent practice is to take this basic instinct and turn it into trust, to build a better partnership for the benefit of all. Think about how your office may be providing care in a manner that could impede this process. Ways you can improve the provider-patient relationship, and build trust in and out of the office include:

• Prioritize Patient Time: Make time spent with patients count for more – this applies to both in-person and virtual visits. This is not a perfunctory obligation on your part, but an essential part of trust-building and care. One interesting idea to help pass time for patients waiting to see a provider is to ask them to write down their questions or symptoms, so they won’t forget anything after you arrive. Minimize charting and maximize engagement during the interaction. Tell the patient what you are doing and explain why it is important.
• Accurate Charting: It is impossible to have informed conversations without good charting information. Electronic Health Records (EHR) from Amazing Charts will make smoother charting a breeze. Use the included templates to maximize your interaction time, fulfill medication needs quickly with e-Prescribing, and enhance between visit communications with the efficient patient portal.
• Improve Listening Skills: At the beginning of the appointment, try asking an open-ended question and letting the patient answer without interruption. Look the patient in the eye, ask clarifying questions, and show that you understand. Rephrase the problem if you need further clarification. Before leaving, ask the patient if there is anything else they want to add. Many surprising bits of information can come out in that “just one more thing” moment.
• Reduce Financial Disagreements: Trust in a medical office can be eroded by financial difficulties, especially in terms of claims that are unpaid or procedures that are not approved. Amazing Charts’ Medical Billing Service is a fully integrated Revenue Cycle Management system that handles the hassle of billing for you, and at a more affordable rate than most third-party billers. Your practice could experience an increase in collections, a higher rate of claims paid on first submission, and a quicker time to payment, making both you and patients happier.
• Show that You Care with Superior Service: Answer the phone, respond to questions on the patient portal, and correspond quickly with other care providers. These seemingly little acts reduce frustration, and make patients feel that their time is valued, too.
• Offer Care Alternatives: Be more open to providing care on the patient’s terms through telehealth, remote care, or virtual care capabilities. Telehealth solutions will increase the ability of your practice to remotely deliver in-home patient care that is comparable to an in-office visit. You and your medical staff can quickly and easily initiate telehealth video and secure text conversations and maintain logs of those chats and videos for billing and audit purposes.
• Increase Financial Transparency: Trust cannot be achieved if patients feel you are not providing full value for the money. Let them know what costs are and explain why a more expensive option might be the most appropriate for a particular condition.
• Share Information More Effectively: The inability of the medical community to efficiently share critical information is not just frustrating for patients; it also erodes trust in the system. Work to achieve interoperability goals, so you can receive information faster, and share information more easily with other medical providers.
• Connect Beyond the Visit: A trusting relationship cannot be built on the ten or fifteen minutes you might be able to spend with patients. Look for other ways to reach out and provide helpful information or motivational tips that might encourage your patients to participate in healthier lifestyle activities.
• Provide Education: An in-person or telehealth visit is usually packed with a lot of information, some of which the patient might not understand. Provide access to informational brochures or upload videos to your website which include more information. If patients still have questions, remind them to use the portal to stay in touch.

Trust doesn’t always come easily, but it can be achieved. In these times when trust seems to be rapidly eroding, it is more important than ever to take the steps necessary to build that trust on every level.