"Your medical patient's trust in you is a fundamental
and essential factor for the growth, profitability, and
success of your private medical practice business."
Trusting is an emotional process by which a person gains assurance that their belief in their physician's professionalism will be confirmed over time. This emotion happens only when it is preceded by a physician’s display of professional competency, knowledge, and special gifted talents and skills.
Trust is accelerated when that patient feels understood, respected, and treated well. This implies that the trustworthiness of a medical doctor is perceived by the patient at every interaction with their medical doctor in their ongoing healthcare.
The question then arises, are you trustworthy? Can you improve your trustworthiness even more? How does doing that improve my medical practice in any significant manner?
Building trust is essential to all relationships.
Trusting people can definitely be improved. Learning how to trust people is important. It’s essential in our society today because of the increasing skepticism, cynicism, and fear of making the wrong choices. In medical practice it’s the increasing lack of doctor-patient rapport.
Dave Bowman, human resources expert, describes in his article, “The Five Best Ways to Build-And Lose Trust In The Workplace,”
Five effective ways to create trust in business settings, which are also reliable in personal trust experiences.
1. Establish and maintain integrity: Your integrity is the cornerstone for trust. Integrity is established by keeping you “word” or promises, being truthful, being always reliable and dependable, being adherent to your core beliefs, completing all tasks, and remain functional regardless of diversity.
2. Doing what’s right: Not doing it for expediency. It means that doing what’s intuitively right may conflict with your personal beliefs, which may put you at personal, social, or professional risk.
3. Communication Clarity: The value of clarity in communication is critical to understanding, decision making, and expected compliance, especially in medical practice. This is also important to effective medical office management. When you avoid explaining your goals, visions, and expectations to your employees, they will inevitably look to their own previous experiences for direction and what they perceive to be compliance with your ideas. Focus on shared goals, not personal, but business.
4. Constant improvement: It includes both your private medical practice and medical practice business management. As Samuel Arbesman reminds us in his book, The Half-Life of Facts: Why Everything We Know Has an Expiration Date, medical students are often told that what you have learned will be outdated in five years. Medical facts, procedures, information, knowledge, strategies, perceptions, and advice are constantly changing.
5. Personal Maturity Adaptations: As your maturity ripens over time you become more malleable, more forgiving, more likely to accept the unintentional mistakes and blunders of our peers and patients, and you adjust your personality to a “let’s get along” mode. The sooner that happens the better doctor you will be. Also, the more trustworthy you become because of your basic need to
be a naturally social human being.
Destroying your trustworthiness, can occur with just one single happening, verbal comment, attitude, harsh words, and profanity.
Once you permit your emotions to override your reasoning, the probability for a permanent regretful event opens. The irrational and unexpected emotional verbal blast reaches beyond the victim’s eardrums. That rampage, whether physical or verbal, reverberates for days, weeks, or years in that victim’s mind.
The recoil from a single event is often enough to terminate a relationship in medical practice or in any business. This is the kind of thing that significantly and permanently changes how the other people who witnessed this disturbing experience, as well as the victim, see you.
It’s something that’s remembered as something to be avoided in the future—who knows if you can be trusted to never do it again, like a ticking time bomb. Apologies help reduce the impact, but not the memory. Future relationships with others who heard about it are also affected negatively.
I have witnessed many of these disturbing episodes in my medical career between patients, physicians, nurses, and other professionals. And, I remember them as if it happened yesterday.
Many times the conflict is of mild consequence and later forgotten. Even then, the memory may be recalled due to some triggering effect, and then can interfere with the expected good results evolving from the subconscious or conscious mind.
Other ways your trustworthiness comes into doubt...
1. Inconsistent behavior or actions - Repetitive changes in how you respond to the same issues create confusion and uncertainty. A pattern of vague or variable behavior means the recipient must never trust how you will respond to issues. It often is the case when patient’s fear revealing their secrets to medical doctors, which may draw criticism or even insults from their physician.
A classic situation like this where the physician verbally attacked my wife a few years back is worth revealing. My wife was referred to a surgeon for treatment of chest pain secondary to restrictive scars from previous breast surgery. She preferred to see that medical doctor by herself and drove to the appointment. About 2 hours later she returned home sobbing and extremely upset.
What she told me next was to me like she had been belittled so intensely by that medical doctor that she basically ran out of the office. The 60 year old medical doctor asked her about her prior chest surgeries which she described to him. When he heard what she had elected to have done several years prior, he rose up from his chair came up to her face to face, and leveled a series of devastating remarks, insinuations about her ignorance about her decisions concerning the prior surgery, and "how dumb can you be to have had that done."
In her words to me she told me that she froze and couldn't speak back to him. My wife had been my medical office manager for 15 years and was loved by everyone she met in the medical community. She was well educated in physician rapport and communications. She had worked many years in other medical doctor offices prior to mine.
Linda told me that she started crying on the spot and needed to get out of that office as quickly as possible. As she left his office and was walking quickly down the hall towards the front door, that physician continued his rant loudly as she walked down the hall, and all the waiting room heard it all. Being loaded with my Vietnam combat experiences, I headed for the car to pay a visit to that surgeon. You might say that I was not in a good mood. However, Linda was quick to persuade me to stay home for some very good reasons, which I did.
After a day or two I wrote a powerful letter to the local medical society chairman describing the incident in detail and made a few strong suggestions as to not only have this physician appear before their ethical committee, but also that he should be booted our of the medical association. I knew how the "clicky" the medical associations are after spending a few years on those committees myself. I requested that they inform me as to how they managed this doctor--never had a communication from them of any type--as I anticipated.
Knowing what that response was likely to be, I wrote the last sentence of my initial letter to the medical association. . ."Sirs, my last suggestion to you might be appropriate in regards to this physician, may I suggest that he in the future hire a bodyguard for his protection when he does the same thing to other patients and a military husband might just be waiting in the waiting room." It was lucky that I wasn't there at that time.
2. Mindset for your personal agenda - Every time you hurry through your patient schedule, you
are doing this. You can’t hide it but you can soften the impact on your patients. My favorite trick for doing that I learned from Robert B. Cialdini, PhD, in his book, “INFLUENCE: The Psychology
of Persuasion.”
His in-depth studies about human behavior are recognized world wide. A person’s intrusiveness into another’s intended activity can be accepted, tolerated, or pardoned when the intruder presents the person with a reason for the intrusion. Almost every time when you offer a person a “because" prefixed to your reason for stepping into their space, that person will almost always
not be offended.
Otherwise, they will. The reason doesn’t even need to be sensible. Learn how to give “because” answers for butting in to a patient’s scheduled office time and visit.
3. Not remembering your patients - Patients expect their doctor to remember them, at least greet them using their first name, or in the case of an older patient, their last name with the appropriate prefixes (Mrs. XXXXX).
The problem is resolved by first scanning their medical record for what you did for their last visit, their name, and treatment before you see the patient. It takes about one minute with a paper chart and a few minutes on your digital communicator... time well spent.
Physicians who enter the exam room and don’t remember the patient or their last visit reduces the patient’s confidence in them... and therefore a bit of their trust. Normally, physicians don’t remember patient’s names or last appointment treatment--but they expect you to know anyway. The smart and "rapport conscious" physicians will do this because it's what 99% of other great doctors won't do.
Patients are disappointed when their doctor doesn’t remember them or their problems, even though we know that we do not have a photographic memory. Try the “one minute drill.” It’s probably the most effective way to create loyalty of your patients that I know.
4. Dishonesty with patients - This can be outright lying to them or simply avoiding important
issues related to their medical care. It’s a complex issue that is skewed by events, personalities,
and medical diagnoses. The question here is, “Do we have a responsibility to reveal everything
to the patient about their care and treatment, even that we consider it to be potentially
damaging to them?”
The concern about medical malpractice risk arises when you limit what you tell patients. Malpractice attorneys have large homes because of what physicians don't inform their patients about. Does full informed consent ring a bell? If you’re doing major surgery, do you tell them they might die during the surgery or afterward? Most medical doctors know how much to tell patients because revealing too much will make patient’s run elsewhere. The next medical doctor may tell the patient the same thing, but by then the patient may accept it (the second opinion myth).
The solution I’ve found useful is by using semantics. Some words are powerful and hit the patient like a sledge hammer, and some are weak that mean the same thing but cause no terror.
Instead of telling a patient they have “malignant cancer,” you can tell them they have a “tumor” that might spread.
Instead of telling a patient they have an “incurable disease,” you could tell them that their disease is, “something that will be needed to be followed for a long time.”
What angers patient’s is discovering later what should have been told to them in the beginning. Patients are not lost because you do that... a fear among physicians that is untrue.
5. Rigid-mindedness - In my last year of medical practice, an associate physician agreed to do surgery on a patient of mine because my hospital contract was ending and I was told not to do surgery for the last 3 months left on the contract. A month later the patient came to me and told me that the physician refused to do the surgery as he had agreed originally.
Turns out that he had a standing rule for himself that a patient had to sign a special consent document in the preop room. It contained rather outrageous statements protecting the medical doctor. The patient refused to sign it and left the hospital with her husband in a rage. I had no idea that this medical doctor required such a thing--I had worked with him for 4 years.
When I confronted that doctor about that problem, he was absolutely unwilling to bend his own rules under any circumstances. I had no idea he felt that way and he didn’t mention it to me during the arrangements we made. Handing your patient off to another doctor to take care of, can be risky and threatening to you.
I practiced with a call group of 6 OBG physicians for over 8 years. We were very compatible and interacted socially and personally much better than I had expected. It was a very comfortable way to practice OBG. A few squabbles happen but were easily resolved. My best friend in the group was very sociable and humorous to be around. He did have very rigid rules that he stood by relating to his practice which were more restrictive than the rest of us.
Our biggest disagreement was about how we would handle paying each other for the delivery of the other physician's patients while on call. We all had good ideas. The problem was that a couple medical doctors had hugh OB practices and others didn't. When I was on call I agreed to deliver their patients without demanding money for it and figured that I might deliver a lot more babies over time of their patients than my own. That was OK. Just having the "on call" coverage for my practice was pay enough for me.
We finally decided to pay each other a hundred dollars for delivering the patients of the other physicians to make up for the imbalance of numbers of deliveries we did while on call. It worked for a year or so. The imbalance of the number of deliveries while on call persisted and the grumbling began. I had followed my own patient during her labor and she was about to deliver in an hour or so and I intended to do the delivery myself rather than let my best friend "on call" do it. I got a phone call that my son had crashed his car and was in the hospital in the next town.
So I asked my doctor friend and associate to deliver the lady. He flat refused, saying that I had told my patient how she would be delivered and he felt that I had brainwashed my patient so much that if he decided to do a C-section on her, she would fight with him. At that time he had the highest C-section rate of 50%, the highest of any OBG at this hospital. Our other associates were unavailable on such short notice to help me. I stayed and delivered my patient myself normally. I never let him deliver a patient of mine again, even if he was on call. The group broke up about a year later.
Medical doctors who practice in a dictatorial manner toward their patients often demonstrate their weaknesses—such as insecurity relative to their knowledge or skills, overt arrogance, or fear of malpractice resulting if they try something different and it goes wrong.
Learn to bend as much as possible with the patient’s wishes or even demands. Patients will respect you more and show much more loyalty to your practice. It’s not hard to prescribe alternative medications, or not do certain procedures during surgery, or refuse certain types of treatment for their medical problem.
Years ago a patient came to me requesting surgery for severe abdominal pain that made her life miserable. She related to me that every Gyn physician in town refused to treat her because of her known abdominal adhesions from a prior surgery. When I saw how miserable she was, tears and all, I agreed to taking a look inside and do what I could, with no guarantees. I scheduled a three hour surgery time as I anticipated a long surgical case. I knew the risk I was taking but even decreasing the pain was worth a try.
Her abdomen was saturated with webs of adhesions in and among most of the abdominal organs. Knowing that the lining of the abdomen (peritoneum) was painful when stretched I disconnected as many adhesion bands to the abdominal wall as possible so that those nerve pain sensors would be not triggered. But the worst and most difficult adhesions to cut were attached to large blood vessels and fragile organs. I washed the abdomen out and added cortisone to help reduce adhesions and inflammation that causes adhesions postop.
It turned out that post surgery that I had punctured a hole in the ureter even though I did the blue dye test for ureter injury during surgery and it was negative. I re-admitted her to the hospital for a very distended abdomen, testing found no evidence of ureter injury, and referred her to the University Medical Center. They uncovered a ureter leak and repaired it. This demonstrates the risk to surgeons who attempt to remove adhesions, the risk that all those other physicians refused to do. I never saw her again and never found out if her pain was gone.
6. Show your incompetence - If you have areas of incompetence, don’t ever reveal that to patients. I’m not saying that a gynecologist shouldn’t tell patients that he doesn’t do heart surgery. What I am saying is that when you don’t feel completely comfortable doing a certain procedure or treatment, then refer the patient to an appropriate specialist.
Patients understand that approach to their care. It indicates to them how much you care for their welfare and outcomes to be top notch.
On the other hand, when a physician blatantly stutters around in front of a patient trying to decide on the appropriate treatment and has to go look it up in a medical textbook first, patients quickly lose trust in the physician.
The solution here is to stick to one proper regimen of treatment and if necessary call the patient the next day and change the prescription, while telling them that you consulted with another doctor to find a better treatment you hadn’t heard of. It doesn’t mean you can’t tell patients that you don’t know the best treatment for their condition, but don’t make a fool out of your incompetence in front of the patient.
7. Berate other doctors - Doing this in front of, or directly to, your patient gives the patients a clear view of what you also think of them... at least it’s their perception. Making statements about how badly the previous doctor treated your new patient is just shooting yourself in the foot.
Most intelligent patients know that such statements are an indication of your own insecurity. The act of belittling someone else is an attempt to elevate your own status. It’s a rather dismal, maybe even destructive, personality habit that serves no one but yourself.
Professionals who berate other professionals don’t deserve to be called professionals. This type of professional evolves into an outsider in the local medical community and commonly loses many patients and referred patients as a result.
Unfortunately, the vine of communications among physicians only, the event is always spread through the physician community by relating other physician's problems, family issues, sex encounters, and medical practice treatment mistakes, with the pretence of warning other doctors not to refer patients to this medical doctor, work with them, or help them in any way--ostracized whether the story was true or not.
So, if you have become involved in some form of medical practice or personal issue that reflects on your integrity, behavior, or less than socially acceptable event, you better believe that every physician in the local area will know it. For most physicians, that is expected and tolerated. However, the real problem is that most married physicians tell their wives about it and that does seriously effect your reputation. Then everybody knows.
“Trust is the glue of life. It’s the most essential ingredient in
effective communications. It’s the foundational principle
that holds all relationships." ---Stephen R. Covey
----Professional Probe----
"Traveling physicians in the early
1900s brough their families along."
Should you have the inclination to avoid taking advantage of the lessons on this website
concerning marketing your private medical practice, you might consider the possibility
of your family ending up as this photo shows you from the 1920s. Never happen... right?
You might find that you'll need to be moving your medical practice often to support
your family--kind of an ultimate example of a traveling physician earning a living making
house calls on the road as you go--and really amounts to "town calls" because small
towns beg for physicians even today.
The diligent pursuit of TRUST, is the greatest adhesive for retention of your patients
that exists today---even if you are forced to move your medical practice.
This rather negative picture of medical life should at least make you wonder a bit
about where private medical practice is headed when our government obtains total
control of our healthcare very soon. The only thing holding them back in 2021 is to destroy/eliminate private medical practice.
But that's not the ultimate disaster we face in the near future as physicians.
Once the government has total control or healthcare, their plan already in
motion is to totally control the medical profession itself.
It's the essence of my book--THE WOUNDED PHYSICIAN PROJECT.
Articles © 2013-2022/CGG INVESTMENTS LLC. All rights reserved. #38, 3-16-22
