Providers can deliver quality healthcare by focusing on this fundamental

Although innovations in diagnostics and treatment are essential to moving medicine forward, there's one aspect of healthcare that will always remain foundational: the connection between patients and their healthcare providers. Even with patient-doctor confidentiality, trust can be lacking in many patient-care scenarios. Here's why putting the effort into building trust matters, and some simple strategies that can help.

Does more trust lead to better care?

According to a 2021 survey done by the University of Chicago, and commissioned by the American Board of Internal Medicine Foundation, patient trust increases with age and income, but overall, about 78% of patients in the survey reported that they trusted their primary physician.

For those who don't have trust, the top reason was, "They spend too little time with me," but there were other factors as well, including a feeling that doctors don't listen to them, don't provide full information, and are too financially motivated. A small percentage didn't trust their doctor simply because the physician didn't make eye contact.

Lack of trust can be a major barrier when trying to deliver quality care. If a patient isn't forthcoming or comfortable, that can lead to providing incomplete information and a subsequently inaccurate diagnosis. For example, if someone has signs of an STI but insists they haven't been sexually active in years even though that's untrue, a physician may look for other causes for those symptoms, putting patients' health at risk from an untreated infection.

A meta-analysis published in 2017 in PLOS ONE found a correlation between patient trust in healthcare professionals and health outcomes. Those who trusted their doctors are more likely to follow treatment instructions, including medication adherence, and even tend to have fewer symptoms, the researchers found. They reported higher satisfaction with treatment and improved quality of life.

Like all aspects of medicine, Covid-19 has become a variable as well, according to a 2020 editorial in JAMA Network. The pandemic has created new threats to trust, and these difficulties build on the already eroding trust seen over the past half-century.

Building stronger relationships

Another notable finding from the University of Chicago survey was that physicians do understand the importance of building trust with patients, but they don't always perform trust-building behaviors. That may be because part of what they believe lowers trust includes:

• High costs
• Challenges with insurance coverage
• Misdiagnosis or medical errors
• Poor clinical outcomes or access to treatment
• Long wait times

None of those factors appeared on the patients' list of why they distrust healthcare providers, however—which means there may be a mismatch in perception.

That said, there were significant areas of overlap, with both physicians and patients noting that trust is built through spending enough time together, showing empathy, listening, and answering questions.

In terms of how to create that type of environment, where both patients and their healthcare providers feel connected to one another, here are some strategies to consider as first steps:

• Make eye contact. Even though the survey respondents put this last on their list, it was still mentioned. Also, some patients may notice this on a subconscious level, leaving them to walk away feeling distrustful but they're not sure why.
• Be transparent. Healthcare affordability is a huge topic, but it often isn't discussed in the context of treatment, which has contributed to receding trust, according to a 2020 viewpoint in JAMA Network. Although a healthcare provider may not have specific numbers—or be able to share them—addressing the potential financial costs of different treatments shows acknowledgment that some patients may have to make decisions based on the health of their bank account, not just their physical health.
• Fight for more time. The main factor that builds trust is time spent in a one-on-one appointment. An opinion piece in Medical Economics suggests that healthcare providers show administrators the research that time leads to trust, which can offer better outcomes. Part of this tactic is finding ways for staff to perform duties that allow for more time with patients. For instance, encouraging patients to come in earlier for appointments and fill out medical history in advance.
• Ask other healthcare providers what they do to build trust, similar to inquiring about new treatment options or condition-specific information. Having an open discussion on the topic could help with brainstorming new ideas about how to deepen patient-physician relationships.

Most of all, remember that trust doesn't provide benefits in only one direction. Physicians who feel they can't rely on their patients will likely feel just as frustrated and exhausted as those on the exam table. Taking the first steps to build trust can go a long way toward improving outcomes and quality of life—for everyone involved.

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