Communication the essence of trust

Ever wondered “Why do my patients do what they do, when they know what they know???”

Working in general medical practice we are presented with opportunities to engage and connect with our patients in a work environment that is so varied and diverse. Those opportunities come packaged in bite sized moments through to dedicated appointments. These opportunities also demand the foundational core skill of connection, the centrality of the human alliance. Most clinicians I have interacted with have communication skills to connect in the briefest of encounters and when there is the time and space their natural human trait shines through like a beacon.

When it comes to working with patients in chronic disease management, the administrative and time pressured burdens we work under have diminished our capacity to use that very core skill that we as clinicians are striving to implement – to empower our patients to have them “do something” rather than “nothing”. I liken the interaction to a ping pong game, one opponent advocating for change to health and lifestyle vs. the justification, defensiveness, and resistance with a patient who feels pressured to have “perfect” health and wellbeing.

I have been a clinician long enough to know how it feels to have an exhaustive workload – one in which I can literally just perform the tasks required for the day. Thankfully those days are less common than not. Also, I have been in situations where my scheduled workload has been interrupted for emergencies and unexpected opportunities to “add” to my current workload. Again, these thankfully are less common than not. Contextually we are all dealing with challenges whether they be staffing, administrative tasks or urgent requests. What is common is that we still have opportunities to connect and I want to suggest that we must seize every opportunity to do this.

Patients do not forget when they connected with you and how that felt. They will seek you out for those snippets of connection which foster the essential trust and rapport that make that central therapeutic alliance. It could be as easy as smiling, stating their first name with genuine care and shaking their hand. Or simply a smile and a wave across the room. A wave if you are out on the street is a very simple gesture of acknowledgement.

As human beings we want to have trust in the important relationships in our lives. Connecting with a human and honouring autonomy (choices) in those interactions is a great first stepping stone to building this trust. Truly and deeply listening and reflecting back to the patient that you not only heard but you “get them” will also go a long way in patients stepping outside of their comfort zone.

So how do we maximise this precious time that we have with our patients? First we can practice, practice and practice our communication skills.  Starting with refining questions that we ask, so that they are open ended. Minimise questions that start with “Do you?, Can you?” and instead try on some questions that begin with “What did you?, How will you?, When can you?” and see what wisdom and nuggets of gold you and your patients uncover together.

Our patients are the experts in their own lives and only they can implement, adopt and make the quality of life they desire for themselves. We are there purely to facilitate these insights and support their efforts at change.

This article was written for Wellcoaches Australia