By Bob Chestnut, MD
“…we are living in this strange time where trust is more important than truth.”
Comedian Hasan Minhaj at the 2017 White House correspondents’ dinner
Most medical school graduates would likely agree that their education was mainly focused on developing medical knowledge. For the purpose of this blog post, I am referring to this as truth. The acquired medical knowledge is the best we have in developing diagnostic and therapeutic plans that may lead to improved patient outcomes. This is a critical component in providing care, but it is often not sufficient in that the right diagnosis and treatment does not automatically guarantee patient empowerment and adherence. The other required component is trust.
Trust may be acquired in many ways. Some are inherent to the role of a medical provider, others need to be acquired through our words and actions. Think of it as a checking account for trust. You are required to make deposits and withdrawals during a patient encounter. The amount of credit or savings you have depends on your patient’s cumulative experience with you. It may also be affected by deposits or withdrawals made by other providers in the past or by current media perceptions of providers. Being conscious of your “balance” with each patient will help you in knowing how to best promote adherence to a treatment plan. I propose the deliberate use of various elements of rhetoric to make deposits in your trust account.
ETHOS – appeal to authority
Congratulations! You already have credit in this area due to your role and your degree. You are a medical provider and your patient has sought you out for medical care. Essentially, your patient has made a deposit in the trust bank, now you need to demonstrate how to build on it. This includes appearing, speaking, and acting like a professional medical provider. Yes, there is room for personal flair which will also likely lead to building more trust, but be sure to respect the trust that your patient has already demonstrated in you. Be the provider that your patient needs AND deserves (loosely adapted from The Dark Knight).
PATHOS – appeal to emotions
Your patient may or may not anticipate that you will build trust in this area. However, this may be the area where you have the most potential. This is where you demonstrate that despite your authority and logic, you are also a warm human who understands what it is like to be a human. Use empathy and statements of validation to build trust which can later be applied toward patient “buy in” when presenting the treatment plan. Use human touch appropriately when entering the room, during your physical exam, or during patient counseling. Use your patient’s preferred name. You will eventually learn which of these methods with a specific patient will lead to the largest and most consistent trust deposits.
LOGOS – appeal to logic
Explain the reasoning behind your decisions in terms or through a medium that is easy for your patient to understand. Speak clearly and honestly with your patient. Your patient came to you because of your medical knowledge, so be sure to give it freely to them.
As it is with most processes, it is important to begin with the end in mind. In this setting, the desired end is improved outcomes. Therefore, all preceding actions should lead to that end. If they do not, they should either be improved or dropped. Practicing and refining any or all of the above elements of rhetoric will likely improve your ability to develop trust and maximize improved patient outcomes.
Bob Chestnut, MD is a third Year Chief Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.