It Takes Two to Trust

Our Mission at Direct Primary Care Clinics LLC is;

“To break down the barriers that currently exist in the patient-physician relationship, to restore mutual trust, and to provide excellent individualized primary health care.”

But how does one “restore mutual trust?”

First, the word “mutual” comes before “trust” in the sentence – not just because of standard English sentence structure, and not just because it is the describer of the noun. Mutual is defined by the Cambridge Dictionary as:

“(of two or more people or groups) feeling the same emotion,
or doing the same thing to or for each other.”

It can also mean holding something in common. This indicates that the trust I will have for the patient must by definition be shared by the patient with me as their physician, and most certainly vice-versa.  The patient’s trust in me must be shared by me, the physician.  This sounds very simple, since it is the basis for all relationships. But it is a rarity in today’s medical world.

Let’s start with the example of a medical problem, such as hypertension (high blood pressure). The patient often does not know they have hypertension, until their blood pressure is taken.  They may not even realize that their recent daily headaches, or the reoccurrence of nagging chest pressure, may both be signs of high blood pressure. But when discovered, it is – or rather, should be – a concern for the patient. It should also be a concern for the physician, and not simply because it falls in their area of expertise. It should create a MUTUAL concern. Now, within their relationship, the patient and physician have a mutual concern. The patient then should trust that the physician has the knowledge and means to help the patient with the problem. The physician should trust that they have the knowledge and motivation to help the patient with the medical concern. But that is not enough to truly constitute trust.

Since I’m into defining for you, let’s see how the Cambridge Dictionary defines Trust:

  • to have confidence in something, or to believe in someone, or
  • to hope and expect something is true.

In our above scenario, the patient should have confidence in the physician and believe the physician is working in their best interests. The patient HOPES and EXPECTS something from the physician. In Mutual Trust, the physician also has confidence – in the patient. The physician HOPES and EXPECTS something from the patient in return. I believe it boils down to this: the patient and physician will be on the same page regarding their hypertension, or whatever the real-world medical problem may be.

It is my belief that this mutual trust is absolutely essential to provide the “excellent individualized primary health care” we commit to in our DPC Clinics Mission.  If the trust is one-sided – either on the side of the patient, or the physician – and not mutual trust, the delivery of excellent care is impeded. If the patient has full trust and confidence in their physician, but the physician is suspicious of the patient and is confident in only their own medical ability, the physician does not – CANNOT – deliver truly excellent care. If the patient is suspicious of the physician and does not have confidence in the physician’s ability or motivation (even when the physician believes in the patient and their integrity), the delivery of care could well be “dead on arrival.” What is the saying? “You can lead a horse to water, but you can’t make it drink.”

This relationship-essential atmosphere of mutual trust has been assaulted by a number of outside sources, which I may touch on in a separate rambling. The concept of restoring this precious thing – mutual trust – is part of our Mission. The relationship has been broken, and building it back together like Humpty Dumpty is exacting and can be tiring. It takes effort, and must be done one person, one interaction at a time. Because it is time-consuming, it cannot be realistically accomplished in 10-15 minute intervals with 40 people a day. When you take into account time for administrative grunt work, not to mention the time required for personal relationship-building, you begin to see that time is the primary obstruction standing in the way of restored mutual trust. This is also why Direct Primary Care (DPC) is the best model for rebuilding that relationship – because we have adjusted our time around building relationships, instead of adjusting our relationship-building to fit the time.

By keeping our patient panel – the number of patients for whom we care – purposefully low, we can spend more time with each individual, provide better communication tools for our patients, and work on restoring mutual trust. Our Mission Statement posted in the DPC waiting room. It’s the first thing you see when you walk through the door and – hopefully – it will be the first thing you notice during your interactions with our DPC Clinics team.

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