If you Google “mistrust doctors”, you find numerous websites expressing concern about the decline in patient trust in doctors. Two points I find interesting:
- Patients don’t trust science
- If a patient doesn’t trust their doctor they don’t follow the doctor’s advice
Patients don’t trust science
What is science? Wikipedia says “The intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experiment.”
I think most people trust the scientific process: You look, you try something and you systematically go through the situation.
Of course, some people cannot be swayed in their belief even by hard evidence. Could it be that there are more and more people believing in things that are not true and cannot be proven? Maybe. On the other hand: There are cases where things are true that are disbelieved because the current evidence is not compelling enough, until the situation becomes dire and everyone asks themselves why they missed the obvious signals… Where is the line between true and false?
Scientific papers can contain errors. Humans can make mistakes. But science is the practice of truth-finding. I think most patients’ mistrust is not about the practice of science itself. Patients want to know the truth of what is going on with their bodies. (Well, most of them. Sometimes they don’t want to know and that’s their good right.) By truth, I don’t mean that a doctor should jump to a definitive answer immediately. I mean that in order to come to a good picture, the doctor needs to be extremely good at listening. They need to tease out all the details. They need to make a map of your symptoms, when they started and how they progressed. Being a doctor is about being Sherlock Holmes. All patients have cancer. It’s just that for the majority, the immune system cleans it up.
Talk to me. Tell me what you have considered and what you have not. Give me all the options. Give me all your hypotheses. Tell me how you are looking at my list of symptoms and how you decide that disease X is unlikely or even 100% ruled out and why disease Y is still possible. Tell me why you are discarding a symptom as irrelevant. Tell me everything that worked for other people and we can methodically figure out if it will work for me.
Maybe I’m different. Maybe that’s just me. How many people get sent home with painkillers and take them because the doctor said so, all the while feeling abandoned and not heard? How many people get misdiagnosed only to figure out the real diagnosis themselves by reading about it in a magazine? How many people are afraid to speak up? The doctor-patient relationship is often one of an imbalance of power. The doctor holds the power. Anyone who denies this is kidding themselves. Doctors have always held power and this will always be the case: A doctor can withhold care. That is power.
Medicine has changed into an institution. Institutions, when they become more important than the people inside it, care only about cramming everything into the structure that the institution prescribes. An institution is an impersonal thing. Anything out of the rigid structure has no place. The only way an institution can be humane, is if the humans inside that institution have the freedom to break every single rule the institution prescribes. A good institution is one where people rarely have to do this.
Doctors have no time. They have precious few minutes to see you and they see many patients. The institution around their profession does not ask them to list all 1001 possible diagnoses and all 2002 possible treatments and cross-check and cross-reference. Precious few doctors build a relationship with their patients nowadays.
Another flaw of medicine as it is practiced in institutions is this: If the patient has a complex presentation, the patient is frowned upon. You should have symptoms ABC. If you don’t, you can’t have disease X. Except the literature is riddled with case studies of people having atypical presentations of illnesses. No wonder people seek out alternative healthcare. Where you can book appointments of an hour or more and where they will actually take the time for you.
I know one patient in particular, who walked around with severe iron deficiency for years, who was shrugged off again and again. She has a rosy complexion. When the iron deficiency finally came to light, she was furious. Years of fatigue had limited her in leading her life. No response from her doctor. None.
If a patient doesn’t trust their doctor they don’t follow the doctor’s advice
This is presented as if the patient not following the doctor’s advice is a bad thing. This is a view from the doctor’s point of view. The doctor is extremely alarmed that their advice cast aside. Either because the patient could die, or because the doctor’s ego is offended. The question you should ask yourself is this: Is the patient happy with the decision to not follow the doctor’s advice? If the answer is yes, there is nothing else to be done there.
Some doctors can get extremely upset that patients go to alternative medicine. That patients seek out second opinions or go for private scans. You shouldn’t be upset about that. Your patient is practicing self-care. You should commend them. Appreciate that they are taking an interest in their health. It’s their health, not yours. Ask them what they are feeling in their body that is moving them to research more and more. Look at their own research, dive into it and figure out if there is merit there, if there’s something missing or not.
Of course, you can talk about the cause: Mistrust. But if someone does not trust you, you can either be upset about it and insist that you are trustworthy. Or you can ask yourself: What reason does this patient have to not trust me or my profession? Because you can bet your ass the patient has a reason. And you can jump up and down all you want that the reason isn’t a good one, that doesn’t make a difference at all to your patient. To your patient, their reason is a good one, or they would have abandoned that reason of their own accord. You can also ask yourself this: What proof of my personal trustworthiness have I given the patient? Just exclaiming that the patient should trust you, is ridiculous. It’s like shouting at an ex-wife that she should still love you. You can’t (ever) tell someone else how you think they should feel.
Why should you trust your doctor? The question makes no sense. You have no obligation whatsoever to trust your doctor. In fact, if you don’t trust your doctor, you need to take that seriously. You need to find healthcare providers that you feel comfortable with.