From “Doctor’s Orders” To Trusted Guidance: The Importance Of Building Trust In Healthcare


Trust is an important undercurrent in many contemporary healthcare trends. From vaccine-hesitancy to the rise of alternative “wellness” care rooted in a sense of affinity and community, healthcare choices are shaped by people’s confidence in their care providers – or lack thereof.

Trust has taken on growing salience in recent decades because patients have become less likely to follow their doctors’ instructions out of sheer deference to authority. As society has changed, parents, employers, teachers and other traditional authority figures have become more flexible and collaborative. A growing share of Canadians has come to expect the same of the healthcare system – from government, to physicians and other healthcare professionals.

But what about expertise? After all, people haven’t historically deferred to their doctors without reason; doctors are highly trained and deeply knowledgeable professionals. Canadians recognize this and value doctors’ expertise; and about nine in ten have a positive impression of doctors as a group.

At the same time, there’s considerable evidence to show that healthcare works best when doctors don’t issue orders but instead engage with and empower people as partners in their own care. Outcomes improve when doctors and patients, as well as allied professionals like nurses and physical therapists, all contribute what they can to the process – and value each other’s insights. On this file, Canadians seem to be less impressed with their physicians: just 17 percent strongly agree that their doctor “takes my personal opinions and perceptions into account.”


Building trust through values

Some Canadians who tend to be deferential in their social values remain quite willing to follow “doctor’s orders.” These folks tend not to ask questions and are fastidiously compliant. But a growing share of Canadians hold values that emphasize autonomy and choice in all aspects of life, including health. How can physicians and institutions earn these Canadians’ trust? How can care providers forge relationships where clinical expertise and patients’ own engagement and motivation all work together to enhance outcomes?

At Environics, we were curious about what the healthcare community and organizations serving Canadians were doing to help build the trust and relationships that lead to better health outcomes. To better understand this topic, we hosted a panel of healthcare leaders who are seeing the demand for increased collaboration and a need for higher trust in their various roles across the system. We had lively discussion about how a range of actors can help prepare the healthcare system for the demands of the future, and how care providers and others can work together to ensure that Canadians have confidence in the system and the care they receive.

Social change is making trust a vital ingredient in effective care.

While there was no one clear answer, most of the discussions boiled down to one simple imperative: humanizing healthcare. One powerful trust-building practice is to simply be empathic in engaging with people. Instead of focusing simply on behaviour – whether patients have done as they were told – it can make a big difference to ask people about aspects of their lives that make compliance difficult. Can they afford the prescription? Do they have trouble finding transportation to their appointments? What worries them most about their diagnosis or health status?

This kind of empathic conversation can also lead care providers to develop a deeper understanding of what patients know about their own health and care, what they’re unsure about, and what they might fear or resist. It’s common for physicians to overestimate patients’ understanding of their own health challenges and care programs; talking openly can reveal important gaps.

Sometimes technology can help. Many patients have experienced the frustration of explaining the history of a condition to their family doctor, then being referred to a specialist, and having to begin the whole story from scratch. This is more than an inconvenience; it makes the process feel untrustworthy, even if each individual in the process seems to be doing their best. Technology can help keep care providers better informed, and make patients feel better understood.

Of course, technology can be a double-edged sword. With more Canadians developing justifiable concerns about the use of their personal data, it’s vital that healthcare providers – whether they’re governments, businesses or others – hold themselves to an exceptionally high standard when it comes to data management. They also need to be totally clear about why and how they’re using patients’ data. Every aspect of the patient relationship has the potential to build or erode trust.


Working with the grain of social change

While this kind of relationship-building comes naturally to some physicians, others may feel they simply don’t have time to have wide-ranging discussions with patients about opinions and preferences that might not be relevant to the situation at hand. There’s no doubt that time is at a premium in most doctors’ offices – but giving patients a quick set of instructions, however sound, and sending them on their way is a false economy. Trust takes time to build; but once it’s in place, it’s a strong and resilient resource that benefits everyone involved. Social change is unlikely to move backward; instead of waiting for a time of greater deference and less questioning to return, many physicians are finding ways to deliver excellent, trust-powered care to patients who are more autonomous and self-directed than ever.

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