January 24, 2018

Trust: The Center of Patient Care

You were trusted by so many and took advantage of countless athletes and their families.” This was some of the very powerful testimony of U.S. gold medalist Aly Raisman at the sentencing trial of (former) Dr. Larry Nassar, who was convicted of molesting scores of athletes during his career. What affected me the most were these words: “The effects of your actions are far-reaching. Abuse goes way beyond the moment, often haunting survivors for the rest of their lives, making it difficult to trust and impacting their relationships. It is all the more devastating when such abuse comes at the hand of such a highly regarded doctor, since it leaves survivors questioning the organizations and even the medical profession itself, upon which so many rely.” Of course Nassar is an ugly outlier. His terrible actions are not reflective of the good work that the millions of doctors all across this country – and across Sound Physicians – do on a daily basis. Still, Ms. Raisman’s words hit very close to home for me because of the issue of trust. She said it best herself: “From the time we are little, we are taught to trust doctors.

Treat trust with the utmost care

A good friend of mine told me about her experience with her 87-year-old father-in-law and prostate cancer treatments. His doctors offered HDRT (after conventional radiation therapy 2 years before) vs. watching and waiting. He chose HDRT and is now struggling with incontinence. She said to me, “He’s an educated man – retired orthodontist and his wife was a nurse. But they trust their docs implicitly, and I’m not sure they were properly counseled on the risk/benefit and possibly diminished quality of life. Some of this is generational. In a way it is an abuse of trust. Docs need to develop the skills to have crucial conversations with patients.” We have to be thinking about this at all times – our patients place their full trust in us to make decisions that can impact their well-being. We must be very careful to treat that trust with utmost care. Our own Lynn Purdy brings up a very important point with respect to trust and end of life, something around which we are each and every day as physicians. “Leading patients and families on near the end of their life,” she says, “when treatment is futile, seems like a breach of trust.” How true this is. How many times do we see patients and their families being told, “Oh, your [insert organ here] is getting better!” by a specialist, all the while knowing that the rest of the body is failing, and it is likely this patient will not survive their current illness? Is this fair to the patient and his or her family? I think about this all the time in the ICU. So many times I have to give the blunt – and difficult – news that their loved one is likely not going to survive. It is very easy to come off as harsh and uncaring.

Earning trust

I tell my patients’ families: “I am not trying to be harsh. However, I think I owe you the truth, and while I don’t mean to crush your hope, it is much worse if I give you false hope.” Giving false hope to a patient or his or her family is a tremendous breach of trust, and we have to be very careful not to cross this line at any time in our career. Trust is earned. This is true in most situations. For those of us blessed to be in healthcare, however, we are almost always given this trust without question. And this is why there is so much pain in Aly Raisman’s statement: the trust she gave Nassar was so viciously betrayed, and it will affect her for the rest of her life. We must always remember that the trust we are given by our patients and their loved ones is so precious, so valuable, and must never be taken for granted. Trust, in fact, is at the center of the relationship we have with our patients: we get frustrated when our patients are not truthful to us, as it makes our jobs that much harder. Well, the same is true with our patients, and we have to always keep this in mind. While most of us would never purposefully mislead our patients, it may not take much for us to lose the trust of our patients and their families, especially in difficult situations, such as the end of life. We must do all that we can to try to make sure this does not happen.

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