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Posted by on Apr 1, 2016 in Bioethics, Patient privacy | 0 comments

Trust in healthcare? (01.04.2016)

Trust in healthcare? (01.04.2016)

Why is trust so important in healthcare?  A 2006 study (1) stated that “People’s trust in health care and health care professionals is essential for the effectiveness of health care”. Another medical journal article (2) argued “that trust is still essential to health care encounters, even if patients today no longer rely exclusively on their ‘family doctor’ as an entry point to care”.

When something goes wrong with our health, we have to trust our nurse, physician, therapist, and other healthcare professionals involved in our diagnosis and care. We have to trust that our laboratory tests were properly processed, that the radiologist correctly interpreted our medical imaging, and that a particular diagnosis is accurate. And then we have to trust that the recommendation, the treatment plan, is the best solution to a specific health issue or set of issues that have been diagnosed.

Trust in healthcare is so important that the Hopkins Center for Health Disparities Solutions (HCHDS) at the Johns Hopkins Bloomberg School of Public Health is conducting a new study; the “Measuring Trust in Health Care: Medical Mistrust Index”. (3) The study summary specifies that:

“Patients must trust that individual health care providers are competent and will have their best interest in mind while making treatment decisions. They must trust that the pharmaceutical companies have developed effective drugs and that the regulatory agencies have adequately monitored them. And, they must trust that the health care organization and that its staff will manage their medical information with discretion and confidentially.”

(As an aside, that last line is why’ve I’ve cross-posted this piece from bioethics to privacy. The protection of identifiable personal health information cuts across almost all aspects of bioethics, and is how I came to be interested enough in privacy to obtain an internationally-recognized certification in privacy protection.)

I’m going to use an analogy to a family event, to talk about trust in healthcare; and yes, I obtained permission from everyone in this photo to post it on-line.

Have you ever rolled your eyes at all of the “I survived 1970s parenting” memes or t-shirts on social media? Silly as they may seem, there’s sometimes a glimmer of truth to them. This is a story about one of my dad’s parenting ideas, but mom seemed to be on board; she was taking photos from the ground!

It would have been in the early 70s when my dad decided it’d be fun to take my sister and me “away up high”. It didn’t matter that there wasn’t a skyscraper – or even a tall building – nearby; he’s a former Navy man, so he’d improvise. Never one for half measures, he hatched his plan; it involved a very tall ladder, a 2nd story roof, 1 adult, and 2 young children. No harnesses, nets, or ropes

We were staying at his parents’ cottage in the mountains, where we spent all the summers of my childhood. This 2-story cottage had been solidly built by his dad and grandfather, and he’d helped with some of the later work when he was a child. I recall that dad went up the ladder first. We scampered up after him, following his advice to look up at him. He didn’t tell us not to look down, because he knew that’s exactly what we would have done if he’d said not to do it. My sister and I were used to climbing a small built-in ladder to get to our bunk beds, so had no qualms about going up the ladder.

I can only imagine, looking back, that the length of the climb on that ladder didn’t register with either of us kids. It must have taken a good few minutes for us to climb to the 2nd floor of the cottage, but I don’t remember that at all. What I do remember is dad plucking me off the end of the ladder, suspended over… nothing. Plopping me onto the lower part of the roof with a stern “Don’t move” as he leaned over to lift my little sister off the ladder.

Take a look at the photo for a moment. Once we were all 3 on the small roof ledge, he lifted my sister and I – one at a time – onto the main roof. With a stern “Stay there!”, until he’d come up to join us. He then took our hands and led us up to the ridge line of the roof, where the two halves of the house met.

You’re probably thinking that’s the end of this story; the 3 of us sitting on the roof, taking in the view. Didn’t I mention that my dad was never one for half measures? The second part of his plan was for each us to walk the ridge line of the roof, holding his hand. Still no ropes or harnesses, for any of us. Walk that ridge line we did, one at a time, each of us kids holding dad’s hand.

Neither my sister nor I recall being scared, and I’m fairly sure I would’ve remembered fear. What I do recall is feeling safe; dad was holding on to me, so it never even occurred to me that I could fall. The three of us even posed for a few photos, which mom snapped from the ground; two stories below.

Photo of children and father on a roof of two-story home

Photo: Carol Woods

I was looking at the view, feeling like I was flying, enthralled by the bird’s-eye view over the forest behind the cottage. Dad pointed out specific trees, and friends’ cottages which we could see from a new perspective. When it was time to come back down off the roof, dad went first and made sure we climbed backwards onto the ladder without looking down. He told us that we had to look up at our hands, on the ladder above our heads, to make sure we had a good grip – and should then just lower a foot to feel for the next rung down the ladder.

What’s the point, or moral, of this little story? The importance of… trust. If either my sister or I had lacked complete trust in our dad, this story would likely have ended badly. One of us could have panicked and done something (more!) dangerous, and perhaps fallen. Or one – or both – of us could have been traumatized and ended up deathly afraid of heights. (Neither of us acrophobia.)

Within healthcare, we know that regression can occur when a person’s ill or injured: “Medical, neurologic, or psychiatric disorders can cause a patient to exhibit regressive behaviors”.(4) Even if a patient doesn’t experience full-blown regression, a person who’s ill or injured is likely to experience feelings of vulnerability; this seems to be particularly true of some elderly and lonely individuals, whether they realize it or not.(5)

The study I mentioned above found that “People’s trust in health care and health care professionals is essential for the effectiveness of health care”.(1) I’m suggesting that, for many, feelings of vulnerability can lead to an even greater desire to be made to feel ‘safe’ and cared for – even if only momentarily – in the way we’d expect a child to feel. When we’re ill or injured, we want to be able to trust the healthcare professionals treating us – the same way that my sister and I trusted our dad not to let us fall off that roof.

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(1) Van den Brink-Muinen, A, and PM Rijken. Does Trust in Health Care Influence the Use of Complementary and Alternative Medicine by Chronically Ill People? BMC Public Health 6 (2006): 188. PMC.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1544335/

(2) Rowe, Rosemary Rowe, and Calnan, Michael. Trust relations in health care – the new agenda. European Journal of Public Health, Volume 16, Issue 1, 1 February 2006, Pages 4–6, https://doi.org/10.1093/eurpub/ckl004.
http://m.eurpub.oxfordjournals.org/content/16/1/4.full

(3) LaVeist, Thomas A. Hopkins Center for Health Disparities Solutions (HCHDS), Johns Hopkins Bloomberg School of Public Health. Measuring Trust in Health Care: Medical Mistrust Index. Web. 12 January 2015. Web.
http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-health-disparities-solutions/Projects/MMT.html

(4) Lokko, Hermioni N., and Theodore A. Stern. Regression: Diagnosis, Evaluation, and Management. The Primary Care Companion for CNS Disorders 17.3 (2015): 10.4088/PCC.14f01761. PMC.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578899/

(5) Vitelli, Romeo. Loneliness, Chronic Illness, and Growing Older. Psychology Today.
https://www.psychologytoday.com/blog/media-spotlight/201501/loneliness-chronic-illness-and-growing-older

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