Trust Your Doctor, If You Can
Posted: Monday, March 02, 2009
by Joel Hirschhorn
http://www.delusionaldemocracy.com
There are good reasons why people should not trust doctors, such as large numbers of people that die every year because of mistakes made by them. But the odds are good, despite qualms about our health care system, that you trust the physicians you use, even if you have not spent much time checking out his or her credentials, capabilities, or evaluations by other patients. With all the talk about how awful our health care system is, what really matters most is whether you have a sound basis for having high trust in the doctors you use, especially surgeons in hospitals.
All this means that the
It is not surprising that about one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published in the journal Medicine. This is all the more reason not to trust doctors.
An excellent paper by surgeons David A. Axelrod and Susan Dorr Goold published in 2000 in the Archives of Surgery [http://archsurg.highwire.org/cgi/reprint/135/1/55] entitled Maintaining Trust in the Surgeon-Patient Relationship cited a survey by the American Medical Association that found 69 percent of Americans are losing faith in physicians (although not necessarily their own physician). The authors made the important point that changes in the structure and financing of the health care system, as well as high costs has weakened peoples' trust in surgeons. In particular, in our modern world patients have the right to make their own health care decisions, even ones that their doctors disagree with. Though people seek the skills and expertise of doctors and may be willing to trust them to keep them alive, they may or may not automatically trust physicians to preserve their quality of life and their privacy.
All too often, physicians are procedure-oriented rather than patient-centered. Nowadays, they also should be concerned about evaluations by patients of outcomes of surgical and other types of medical therapies. This should lead to more concerns by doctors to think beyond the technical success of procedures or medicines and consider whether patients see their lives improving if they do what doctors prescribe. When doctors take a broader perspective patients can have greater trust in them. In other words, when doctors honestly and sincerely express interest in the wishes and preferences of patients, especially at the time of decision making by them to use what the doctor says is the best medical route to take, trust can be improved because of a wider view of benefits to be realized by the patient.
What all this means to me is that a doctor having what we think of as a great bedside manner takes the time to relate to a patient as a real human being, not merely as the recipient of medical technology, expertise or procedure. We have a right to be choosey and to make medical decisions based on how well a doctor has behaved with us in ways that make us have trust in them, and whether it seems clear that they think of us first.
All too often, doctors make their patients feel like they are just filling a small time slot available to deal with them. A take-it-or-reject-it kind of behavior is not likely to produce real trust in a physician. Getting time is not the same as getting real care and concern. We have a right to feel safe, genuinely cared about and important, if we are to place our utmost trust in a doctor. Doctors must show interest in our lives, not just our immediate medical problem. All this is as important as believing that the doctor really knows what he or she is doing, either as a specialist or general practitioner.
Why even care about this trust issue between patients and doctors? Many research studies have found that medical outcomes are better for patients when they have more trust in their doctors. But does low trust produce worse health care or does inferior health care produce less trust?
For example, Stefanie Mollborn reported in the journal Health Services Research [http://www.bio-medicine.org/medicine-news/Trust-in-Doctor-gives-better-cure-6189-1] that patients with higher levels of trust in their regular physicians were more likely than patients with less trust to have better care. Less trust was associated with delayed care and especially with unmet health care needs in most patients. One interpretation was that physicians who rush and fail to address all of a patient's needs cause lower levels of trust. But another view is that higher trust can produce better follow-up by patients with more adherence to prescribed treatment and medicines, and possibly diet and exercise recommendations, for example.
A big problem these days with people facing poor financial health is skipping prescribed medicines, especially ones needed to treat chronic diseases such as diabetes and heart conditions. Interestingly, a study reported in the Archives of Internal Medicine [http://www.bio-medicine.org/medicine-news/Trust-In-Doctors-Can-Affect-Taking-Medications-4475-1/] found that nearly 30 percent of people who reported low levels of trust in their doctors and had monthly drug costs over $100 said they skipped medicines due to cost, compared with 11 percent of those who had a more trusting relationship with their doctor and the same level of cost. A big problem is that people with diabetes who fail to take their prescribed medicines may have poor blood sugar control and a higher risk of heart attacks, strokes, blindness, kidney failure and amputation.
We can have too much trust in doctors. And we can have too little trust in them. Trust should not be automatic, just because someone has a degree in medicine. It should be earned through providing the very best total experience for patients, as well as by having superior, proven technical skills and capabilities. Considering the increasingly unaffordable high costs of health care, it is up to us, the patients, to thoroughly examine, evaluate and judge the physicians that we entrust our lives to. It seems that we need to spend more time and effort doing all this.
About a year ago the
First do no harm, should be something patients think about when choosing a new physician or deciding to keep using a familiar one.
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