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The power of trust.

December 22, 2011

We are asked to trust our doctors.  In fact, we are quite dependent on them whether we trust them or not.  Not only for treatment of illness or symptoms, but for documentation of our condition.  Notes for work, forms for FMLA or insurance claims, letters for disability claims or grant requests.  The doctor holds a lot of power in this relationship.  How often, though, does the doctor trust the patient?

Anecdotally, I have heard stories from many people of the distrust their doctor holds for them.  I experienced this distrust myself when, in one instance, a doctor insisted my high fat diet was responsible for my high triglycerides despite my repeated explanation to her that I was following a strict vegan, no-added-fats diet ala Dean Ornish at the time.  I later read my medical records from this institution and on one page there is her note declaring me “hysterical” and in need of medication adjustment (when I cried in the face of her baseless accusations) and insisting my “high fat diet” was responsible for my dislipidemia.  The next pages hold my 3 day food diary and the dietitian’s notes stating my diet was high in carbs and deficient in protein and suggested adding a little more healthy fats.  From the stories people tell me, this type of distrust on the part of the treating physician is a daily occurrence.

Is it important for the doctor to trust the patient?  How much does this matter?  It depends on how you see the doctor patient relationship.  If you buy in to the old school model of the paternalistic doctor dispensing care and the patient receiving it passively, it probably isn’t that important.  However, if you view your relationship with your doctor(s) as a collaborative partnership aimed at improving your health, trust seems crucial.

Another interesting question is this:  does the doctor need to like the patient to provide adequate care?  We all want to be liked and respected.  Do we need it in order to be healthier?  The Dalai Lama addresses this point in his discussion of compassion found on his official website.

Similarly, if one is sick and being treated in hospital by a doctor who evinces a warm human feeling, one feels at ease and the doctors’ desire to give the best possible care is itself curative, irrespective of the degree of his or her technical skill. On the other hand, if one’s doctor lacks human feeling and displays an unfriendly expression, impatience or casual disregard, one will feel anxious, even if he or she is the most highly qualified doctor and the disease has been correctly diagnosed and the right medication prescribed. Inevitably, patients’ feelings make a difference to the quality and completeness of their recovery.

It’s a good point and one I’ve found to be true in my own treatment.  A good example is the contrast between the styles (or “bedside manner”) of my cardiologist and one of his partners.  The partner visited me several times in the hospital after my heart attack and I saw him once in the office when my cardiologist was called away for an emergency.  My cardiologist displays the hurriedness almost all doctors have, but also takes time to listen when I make it clear I need to tell him something important.  He shows empathy and understanding when I am distressed.  He took time to express concern about the well being of my sister and husband while I was in the hospital when he could see the toll worry was taking on them.  I generally leave his office feeling cared for and like he wants to help me.  In contrast, his partner frequently dismisses my questions.  He seems to be a capable doctor, but when he says “Don’t worry about it”, it has the opposite effect for me.  In the office, when he dismissed my reports of fatigue and frequent angina with “you have a strong heart,”  I felt anything but reassured.

This week I visited my cardiologist to talk about my continuing angina and my decision to apply for Social Security Disability.  I had a great deal of anxiety going into this meeting.  I feared my doctor would tell me I was just not trying hard enough, even though I had struggled for the last year to meet my work obligations and had multiple hospitalizations.  He looked me straight in the face and told me, “I see your pain and I believe you.”  I think this is the most powerful thing a doctor has ever told me.

What have your experiences been?  I’d like to hear your stories of trust or distrust in your doctor patient relationship and how it has affected your health.

2 Comments leave one →
  1. PVeeS permalink
    December 22, 2011 4:16 pm

    I’m a 44 year old woman with no risk factors, and I have had a spontaneous coronary artery dissection (SCAD) and two heart attacks. Mistrust from my first cardiologist has been them most dangerous part of my recovery. He kept treating me like a rebellious teenager every time I had a question about medication or side effects. I happen to respond very badly, sometimes to the point of life threateningly, to many heart medications. His habit of minimizing my complaints could have killed me, and did damaged my quality of life for a while. For my particular condition, non-invasice prevention such as diet, exercise, and stress management are powerful preventatives. It seems like doctors don’t think they have helped unless they prescribe a pill. This frustrates me because the third leading cause of death in the USA is prescription medications taken according to doctors instructions.

    My primary care provider (pcp) takes time to listen, and so does my new cardiologist. I prefer the pcp because I’ve been his patient for a long time, so he knows me. I believe he trusts me and genuinely cares for my well being. Recently my pcp took over my medications. I still feel like neither doctor completely trusts how effective the stress management is, but they are working with me, and I feel their concern. Within 90 days of this new format for my treatment team, I’ve made more progress than the previous 12 months even though I’m on far less medication. We’re still working on the drug part, but having positive doctor patient relationships have made all the difference.

  2. Kristen Hart permalink
    February 15, 2012 3:11 am

    In the last three years I have learned a lot about doctors. When I had my first heart attack and was in the hospital, I actually told the cardiologist to get the hell out of my room or I would. So I had another cardiologist that I thought was a good doctor. For a year and a half I kept telling him that I was always out of breath, most days I couldn’t get out of bed, I had no energy. He told me it wasn’t my heart because they had fixed it when they put in the stents. He recommended I see my GP.
    After a year and a half I got swine flu and was in the emergency room. The doctor asked if I had heart failure. I told her no. She couldn’t believe it. She told me I definately have CHF. They did an echo and my ejection fraction was between 20 & 25%.
    After recovering from the flu my GP told me I was disabled and should qualify for social security. Of course, my cardiologist still was saying there was nothing wrong with me and that is what he to social security. Of course I was denied.
    In February 2011 I had another heart attack, and thank god I found a different cardiologist. But still, even though I like this cardiologist, and he takes the time to listen to me, I’m still in the dark. I refiled for social security and the doctors office sent me a copy of the forms they filled out.
    It was then I learned that not only did I have CHF, I also have advanced cardiomyopathy, an atrial fibrillation, coronary artery disease and he went on to say I was a “cardiac cripple”.
    For three years I had no idea what my actual condition was. I was starting to think I was crazy since no one would give me an explanation for all the symptoms I was having.
    I wish there was some kind of checklist of every possible question we should ask when going to the doctor, but this wouldn’t help if they don’t even bother telling you what is actually wrong!

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