Making Room for Trust in the Doctor/Patient Relationship | Miri Lader, MD | TEDxDayton

Summary

The speaker, a pediatrician and combat soldier, addresses the critical issue of trust in medicine, exacerbated by the COVID-19 pandemic. Highlighting the importance of a collaborative three-way relationship between doctors, patients, and caregivers, the speaker calls for a reevaluation of medical practices, including discrimination, cost barriers, and educational gaps. With the alternative medicine industry booming, the speaker urges collective responsibility to restore trust and suggests practical steps like virtual presence to improve patient outcomes, emphasizing the need for a united front against disease.

Takeaways

• 🌟 The COVID-19 pandemic highlighted a significant lack of trust in science and medicine, which had severe consequences.
• 👨‍⚕️ Pediatricians are trained to establish trust quickly in a three-way relationship involving the doctor, patient, and caregiver.
• 🤝 A review in the New England Journal of Medicine found that parents trusted their child's care provider more when communication was collaborative.
• 🗡️ The speaker, a pediatrician and combat soldier, emphasizes the life-or-death importance of trust in leadership, drawing parallels to the medical field during the pandemic.
• 🤕 The speaker acknowledges the personal harm caused by medicine and the emotional toll of realizing the extent of this damage.
• 🏥 The medical field's lack of trust is partly due to some doctors not prioritizing patient care and safety as they should.
• 👩‍👧 As a mother, the speaker feels a responsibility to address the issue of trust in medicine for the sake of her children's future healthcare.
• 🔍 Trust is defined as choosing to make something important to you vulnerable to the actions of someone else, highlighting the risk involved in trusting healthcare providers.
• 💊 The alternative medicine industry's growth to a $100 billion market indicates a shift in patient trust towards non-Western medicine.
• 🏥🚫 Issues like discrimination, socioeconomic disparities, and educational gaps contribute to the erosion of trust in the medical system.
• 👩‍⚕️📱 Innovative solutions like using technology to include loved ones virtually can improve patient experience and satisfaction, as demonstrated by Dr. Barrett's story.

Q & A

What is the main issue highlighted by the speaker regarding the medical field?

The speaker highlights the issue of lack of trust in the medical field, which has been exacerbated by the COVID-19 pandemic, and how this lack of trust has led to negative outcomes, including loss of life.

What is unique about the practice of pediatrics according to the speaker?

The speaker explains that pediatrics is unique because it involves a three-way relationship between the doctor, the patient, and the caregiver, and that pediatricians are trained to establish trust quickly in this context.

Why is trust important in the doctor-patient relationship according to the New England Journal of Medicine review mentioned in the script?

The review found that parents trusted their child's care provider more when communication was geared towards collaboration, indicating that trust is crucial for effective teamwork and patient satisfaction.

What is the speaker's dual background that influences her perspective on trust in the medical field?

The speaker is both a pediatrician and a trained combat soldier, and she uses the concept of trust from both fields to emphasize its importance in the medical field, especially during a crisis like a pandemic.

What is the speaker's personal dilemma regarding trust in the medical field?

The speaker struggles with the fact that while she entered medicine to help people and finds fulfillment in it, she has discovered that not all doctors share the same commitment, and this realization challenges her belief in the medical field's trustworthiness.

What is the definition of trust provided by Charles Feldman in the script?

Charles Feldman defines trust as choosing to make something that's important to you vulnerable to the actions of someone else.

How has the lack of trust in Western medicine impacted the alternative medicine industry?

The lack of trust has led to a significant increase in the value of the alternative medicine industry, which grew to $100 billion, a 38% increase from pre-pandemic times, indicating that patients are seeking medical advice outside of Western medicine.

What is one example given in the script to illustrate the impact of socioeconomic status on health outcomes?

The script mentions a study from California that found COVID-19 patients from wealthier areas were less likely to be hospitalized than those from poorer areas, suggesting disparities in access to health care and healthy lifestyles.

What is the speaker's proposal to improve the doctor-patient relationship and increase trust?

The speaker proposes making it a universal expectation to have a third person present at every doctor's visit, someone who can help the patient remember questions, take notes, or serve as a reminder to the doctor of the patient's value as a loved one.

What is the significance of the iPad initiative mentioned by Dr. Barrett in the script?

Dr. Barrett's initiative to use an iPad to connect patients with their loved ones virtually during hospital visits shows the importance of emotional support and presence in patient care, which can improve patient experience and satisfaction.

How does the speaker describe the current dynamic between doctors and patients in relation to disease?

The speaker describes the current dynamic as a war between doctors and patients, while the real enemy, disease, continues to cause harm, emphasizing the need for trust and collaboration to effectively combat health issues.

Outlines

00:00

😔 Trust in Medicine: The Pandemic's Impact

The speaker, a pediatrician and combat soldier, discusses the pandemic's revelation of the public's lack of trust in science and medicine, which led to unnecessary deaths. They emphasize the importance of establishing trust quickly in pediatrics through a three-way relationship between doctor, patient, and caregiver. A 2012 review in the New England Journal of Medicine is cited, showing that parents trust their child's provider more when communication is collaborative. The speaker acknowledges the medical field's shortcomings and the personal harm caused to many, expressing a deep concern for their own children's future healthcare.

05:02

🤔 The Search for Trust Beyond Western Medicine

This paragraph delves into the reasons why patients are turning to alternative medicine, which has seen a significant increase in value since the pandemic. The speaker points out that the lack of trust in Western medicine is leading patients to seek advice elsewhere. They highlight issues such as discrimination in medicine, particularly towards LGBTQ+ adolescents, and economic disparities in healthcare access. The speaker also touches on educational gaps in understanding science and the medical field's collective responsibility to rebuild trust.

10:03

👥 The Power of a Three-Way Relationship in Healthcare

The final paragraph focuses on the importance of including a third person in doctor-patient interactions to improve patient experience and outcomes. The speaker shares a story about Dr. Barrett, who used an iPad to include a patient's loved one virtually during hospital visits, enhancing the patient's experience. A study in the Journal of Education and Health Promotion supports this approach, showing improved patient satisfaction. The speaker calls for a universal expectation of a three-way relationship in healthcare to foster trust and respect between doctors and patients.

Keywords

💡Trust

Trust, in the context of the video, refers to the confidence individuals place in their healthcare providers, which is crucial for effective medical care. The video emphasizes the importance of trust in the doctor-patient relationship, as it can significantly impact patient outcomes. For example, the speaker mentions that the lack of trust in medicine during the COVID-19 pandemic led to many deaths due to non-compliance with medical advice.

💡Pediatrics

Pediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. The video highlights the unique aspect of pediatrics where there are at least three parties involved in the care process: the doctor, the patient, and the caregiver. This three-way relationship is essential for building trust quickly, which is a central theme of the video.

💡Collaboration

Collaboration is the act of working together towards a common goal, and in the video, it is presented as a key component of the doctor-patient relationship. The New England Journal of Medicine review cited in the script found that parents trusted their child's care provider more when communication was geared towards collaboration, illustrating the importance of a team approach in healthcare.

💡Combat Soldier

A combat soldier is a member of the military trained to engage in warfare. The speaker uses the analogy of being a combat soldier to emphasize the critical nature of trust in life-or-death situations, drawing a parallel to the trust required between patients and healthcare providers during a pandemic.

💡Alternative Medicine

Alternative medicine refers to healing practices outside the realm of conventional Western medicine. The video points out the growth of the alternative medicine industry as an indicator of the lack of trust in traditional medicine, with patients seeking advice outside of Western medicine when they do not feel safe or respected within it.

💡LGBTQ Adolescents

LGBTQ stands for lesbian, gay, bisexual, transgender, and queer or questioning. The video discusses the specific challenges faced by LGBTQ adolescents in seeking medical care due to fear of discrimination or lack of safety, which is a part of the broader issue of trust in medicine.

💡Healthcare Disparities

Healthcare disparities refer to the differences in the quality of healthcare received by different groups of people, often influenced by factors such as socioeconomic status. The script mentions a study comparing COVID-19 patients from different socioeconomic backgrounds, highlighting the disparities in healthcare access and outcomes.

💡Educational Gaps

Educational gaps refer to the differences in knowledge or learning opportunities available to different individuals or groups. In the video, the speaker points out the lack of education on customer service and the scientific method as contributing factors to the communication breakdown between doctors and patients.

💡Collective Responsibility

Collective responsibility implies that all members of a group share the duty to address a problem. The video speaker argues that fixing the lack of trust in medicine is not the fault of any one individual but a collective responsibility that requires a joint effort from both healthcare providers and patients.

💡Patient Experience

Patient experience encompasses all aspects of care, from the patient's perspective, including how they feel they are treated and the quality of communication with healthcare providers. The video shares a story of Dr. Barrett using an iPad to include a patient's loved one virtually, which improved the patient experience by creating a three-way relationship and showing respect for the patient's emotional needs.

💡Disease

Disease refers to any abnormal condition that negatively affects the structure or function of an organism. In the video, disease is portrayed as the common enemy of both doctors and patients, emphasizing the need for unity and trust in the fight against illness, rather than being at odds with each other.

Highlights

The COVID-19 pandemic exposed a lack of trust in science and medicine, which had fatal consequences.

Pediatrics involves a three-way relationship between doctor, patient, and caregiver, with trust being crucial.

A 2012 review in the New England Journal of Medicine found that collaborative communication fosters trust between parents and providers.

The speaker's dual role as a pediatrician and combat soldier emphasizes the importance of trust in life-or-death situations.

Despite the pandemic, there was a lack of trust in medical leadership, leading to unnecessary loss of life.

The speaker's naivety about the extent of personal harm caused by medicine was shattered by numerous stories of patients.

Some doctors do not prioritize patient well-being, which challenges the idea of trusting the medical field.

As a mother, the speaker is compelled to advocate for trust in medicine for the sake of her children's future care.

Charles Feldman's definition of trust is presented as choosing vulnerability to the actions of others.

The alternative medicine industry's growth indicates a shift in patient trust from Western medicine.

LGBTQ+ adolescents are less likely to seek medical attention due to fear of discrimination.

Economic disparities were evident in COVID-19 hospitalization rates, with poorer populations being sicker.

Educational gaps in understanding science and medicine contribute to the trust crisis.

The lack of trust is a complex issue with no single solution, and it requires collective responsibility to fix.

Dr. Barrett's use of an iPad to include loved ones virtually during patient care improved patient experience and satisfaction.

The speaker calls for a universal expectation of having a third person present at every doctor's visit to enhance trust.

Doctors and patients must work together to overcome the trust crisis and effectively combat disease.

Transcripts

[Music]

[Applause]

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ah

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the coven 19 pandemic shined a light on

the lack of trust we have in science and

medicine

and the ugly fact that this lack in

trust

killed so many of us

i'm a pediatrician

and something that sets the practice of

pediatrics apart from adult medicine is

that in any given situation there are

always at least three people

a doctor a patient and a caregiver

for this three-way relationship to work

pediatricians are trained to establish

trust very quickly

this three-way relationship is how we

create the space to start building that

trust

the new england journal of medicine

published a review in 2012 that found

that more parents trusted their child's

care provider when communication was

geared towards collaboration

a sort of teamwork that's lost when the

entire team is only two people

i'm also a trained combat soldier

and on the battlefield if you can't

trust the person leading your squad

you

will

die

unfortunately despite the fact that

patients didn't trust their medical

leadership we were all thrown into a

pandemic combat zone in early 2020

no general would ever have allowed this

kind of unit

into battle

because it would cost too much human

life

which it did

which it still is

when i first had the idea to talk about

this

i was naive

i honestly had no idea

how many people have been personally

hurt by medicine physically hurts

harmed

emotionally scarred

the more i asked the more stories kept

coming and at a certain point i needed

to walk away

all that hurts and yet somehow so many

in the field had no idea it was

happening

i went into medicine

because i refill my emotional tank by

helping people

i don't rest until my little patients

are medically safe

there are times that i spend days away

from my own children because somebody

else's child needs me more

i just couldn't fathom

that there were doctors not like that

but i was wrong

some aren't

and now

knowing this

how dare i ask anybody to consider

trusting the medical field when the

truth is

the field doesn't deserve it

but i'm a mom

and soon my kids are going to need an

adult doctor and i won't be able to

control the kind of medical care they

get

for them

i can't back down from this conversation

for them

i have to speak through this

embarrassment

and ask to be heard

because what's stronger than my shame

in the pain that's been done

is my fear that we keep letting this

happen

we

doctors and patients

we can't sit with this anymore

so today i dare talk about trust

and the best definition of trust i've

ever come across is this one by charles

feldman

trusts

is choosing to make something that's

important to you

vulnerable to the actions of someone

else

there are times when we let ourselves

trust somebody for example when that

check engine light comes on in the car

do i trust that it won't be upsold or

overcharged no

but

i end up in a garage where i can trust

that i won't die on my drive home

because of faulty brakes

see we choose to trust the mechanic

every time we put our family back in the

car

after it's been tinkered with

trusting somebody with something that's

important to us

is not new but what's the opposite of

trust

how about

not feeling safe

when we don't feel safe in our time of

need we naturally go elsewhere

did you know that the alternative

medicine industry is worth 100 billion

dollars nowadays

that's a 38

increase from pre-pandemic 2019

and don't get me wrong there are a lot

of benefits to these practices but

what this tells me

is that more and more patients are

seeking medical advice

outside of western medicine

when we don't believe that our health or

well-being are safe in the hands of

doctors we naturally seek help

elsewhere

how did we get here

let's take a moment to shine a light on

only some of the ways this problem got

so big

this list does not encompass all of the

ways in which discrimination can be

found in medicine

still a population that i work quite a

bit with are the lgbtq adolescents

now in general those who identify as

lgbtq plus are less likely to seek

medical attention

a large population survey out in canada

looked at the why and found that for the

most part it was out of fear that they

wouldn't find a doctor they could safely

turn to

in other words

they did not feel that they would be

kept safe

and they have the historical evidence to

prove it

why are the things that we need to

survive so expensive

2020 out in california they compared

covet 19 patients and found that those

from the richer side of town were less

likely to be hospitalized with their

covid

than those from the poorer side of town

the idea is that it probably has to do

with access to fresh and healthy foods

preventative health care

in general the privilege of living a

healthier lifestyle before they got sick

but the bottom line is this

the sicker people were the ones who were

poorer

we have deep rooted educational gaps

and they're causing us a lot of problems

by all measure i'm a very educated woman

i have never been taught

customer service

or how to run a private practice

let's take that all the way back to high

school where universally

students don't all get taught the ins

and outs of the scientific method

it's no wonder

people are having such a hard time

speaking the same language

this is a lot

and unfortunately

there's not a single solution

because the lack of trust is not a

single problem

it's the outcome of a whole lot of

problems

and even though the pain and the harm is

not your fault

fixing it is our collective

responsibility

ultimately i want to empower each of us

go out find that trustworthy doctor

don't stop until you find them

but until we do

what are we supposed to do to keep

ourselves safe

let me tell you about dr barrett

she was telling me that the strict no

visitor policy in her hospital resulted

in a lot of her patients

fighting for their life alone

seeing how much this was bothering them

she decided to start bringing an ipad in

with her every time she examined them

she'd use that ipad to call whichever

loved one her patient wanted that day

and suddenly

it wasn't just the two of them anymore

but this three-way relationship was

formed

by being present even virtually this

third person contributed to improved

patient experience for her patients

a large study published in the journal

of education and health promotion found

the exact same results

not only improvement in patient outcome

but improved patient satisfaction scores

from 55 to 61

with this intervention alone

i think that that's something tangible

that we can all commit to making it a

universal expectation that we will have

a third person at every doctor's visit

with us

somebody to help us remember what

questions we wanted to ask

or take notes with us

or even just to sit there silently

as a visual reminder to the doctor

that even though we're adults

we are somebody's loved one

and we deserve the utmost respect

and the best medical care

right now

it feels a lot like doctors and patients

are at war with each other

all the while

our common enemy

disease

keeps costing us casualties

we have to start making room for trust

in this relationship

because only side by side

can we finally win this war

[Applause]

[Music]

[Applause]

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you