Trust in the Healthcare System

In this article, Dhweeja Dasarathy ’21 takes aim at the strain that information overload and mechanical hospital administration puts on patient-provider relationships.

 

The door squeaks open as Dr. Roberts opens the door and introduces herself to the patient who is donning the stereotypical light blue with white polka-dots hospital gown. 

“Good morning! What can I help you with today?” Dr. Roberts cheerily begins her consultation as she sits at her computer to begin typing up the patient’s chart. 

“I…I’m fine, but lately I have been having a lot of anxiety, and I’m not sure who to talk to about this,” the patient replies. She is about 25 years old. Her forehead creases with a worried expression, her eyebrows furrow, and her eyes glisten as she speaks. 

There is a period of silence. Dr. Roberts’ typing is the only sound in the room. 

Click clack click clack. Silence. Click clack click clack. Silence. 

Dr. Roberts stops typing and turns towards the patient, bends forward, and takes the patient’s hands in hers. 

“You can talk to me. Tell me, what is going on?” 

The patient begins talking, and as she speaks, I can sense her relief, her release of her pent up anxiety, and a brief release of the frown on her brows as a hint of a smile begins to lighten up her face. 

“I’m ok…but lately I have been having a lot of anxiety. I’ve been physically abused twice now, and my ex-husband is being released from prison. I don’t feel safe…” 

Beep beep. 

It’s the sound of Dr. Robert’s pager. She ignores it and hurriedly turns it off before the second round of insistent beeps. 

“I can’t imagine how hard this situation must be for you, I’m so sorry … please, continue.” Dr. Roberts responds.

“Well, when I was younger, my parents were both alcoholics and I was placed in a foster home. My foster mom was verbally abusive and my foster father was physically abusive. I ran away from home when I was 16 and began working to try to make ends meet. That’s where I met my first husband who was violent, abusive, and was constantly using…” 

Knock Knock. 

“Dr. Roberts, there’s a new admission that requires attention soon.” 

Dr. Roberts ignores it and continues listening to her patient. 

“For the past few years, I’ve been living in a shelter. I’ve recently been diagnosed with depression and am taking medications, but how do I get over this overwhelming sense of anxiety and loneliness that I am feeling?” 

*** 

This is one of the stories that I heard as I was shadowing at a hospital in Cleveland. It seems to be ubiquitous – the feeling of being alone, the lack of trust in physicians, the constant rush that physicians face – the overwhelming, nagging feeling that there were 20 other patients to see and that there was just not enough time to spend an hour with one patient. All of this seems to culminate in a progressive decline in faith in the healthcare system. 

This lack of confidence in their physicians leads patients to avoid communicating honestly with their physicians, revealing their full history, and why they partake in certain harmful habits. 

Studies have shown that only 25% of Americans truly trust their physician. Blendon et al. in the New England Journal of Medicine reported that the United States ranked near the bottom of trust levels among 29 other countries (Blendon, 2014). However, if this feeling translates to the patients who then do not open up to their physician, it ultimately affects their quality of care, an issue that the healthcare arena needs to explore and resolve before further deterioration in health care outcomes of the population. 

A number of underlying issues may contribute to this disintegration in communication between patients and their doctors because it was not always like this.  Social and economic changes have resulted in a progressive increase in the uninsured population who lack continuity of care: they are instead receiving twenty-minute office visits with the ongoing demands of electronic medical records that is slowly but surely transforming doctors from caring humans to scribes who have to be an expert in computers, data mining, and revenue management. 

Oftentimes, the same doctor does not see the same patient, especially in hospitals that have a centralized scheduling system. Due to this lack of continuity, a patient does not feel comfortable discussing his/her hidden personal history with a new doctor during each visit. 

Another issue is that doctors continually remind a patient of habits that may not even have to do with the issue that they come in with based on recommendations and guidelines from several organizations. It has been reported that for patients who are overweight, regardless of whether or not their visit has to do with their weight, the physician will manage to bring it up in the conversation. This constant reminder often further deters patients from being honest with their doctors. 

Patients feel the pressure of constant reminders of habitual choices, fear of being considered “difficult,” and information overload of healthcare options available from the internet and social media (Shu, 2012). Finally, patients may not fully disclose their fears and concerns to their physicians out of a sense of feeling rushed. This is partially due to the increasing burden on physicians to evaluate an increasing number of patients that results in overt and sometimes subconscious pressure to shorten each patient care visit so they can move on to the next patient. 

For physicians, seeing a patient should not feel like another box they check off on their task list, and for patients, seeing their physician should be a way to communicate and open up about any mental or physical stressors they are undergoing. Improvements on this front need to be rapidly made in order to address this major issue in the healthcare field today. 

The roles of open access, unfettered information, social media, and increasing cost of health care need to be evaluated if we are to improve the lives of patients. We must remember that doctors are humans too; however, expecting them to be superhumans will only lead to further corrosion of confidence and trust of patients in their physicians. 

 

References: 

Blendon, Robert J., et al. “Public Trust in Physicians — U.S. Medicine in International Perspective.” New England Journal of Medicine, vol. 371, no. 17, 2014, pp. 1570–1572., doi:10.1056/nejmp1407373.

Shu, Dr. Jennifer. “Are You Afraid to Talk to Your Doctor?” CNN, Cable News Network, 31 May 2012, http://www.cnn.com/2012/05/31/health/living-well/afraid-talk-doctor/index.html.

 

 

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