The Vice President of Health Equity and Community Partnerships at Corewell Health and a Professor of Medicine at Johns Hopkins share examples of lack of trust and respect on both the part of patients and clinicians, and the problems these issues create. They discuss how clinicians can shift the narrative toward more trust so that clinicians can better respect individual patients and so that patients can in turn trust their clinicians.
From the NEJM Catalyst event Social Needs and SDOH: Impact on Patients & Communities, sponsored by Optum, March 9, 2023.
Lynn Todman, PhD, Vice President of Health Equity and Community Partnerships at Corewell Health, and Mary Catherine Beach, MD, MPH, a professor of medicine and of health at Johns Hopkins School of Medicine and Bloomberg School of Public Health, discuss the importance of building trust and respect to effectively help address patients’ social determinants of health (SDOH).
Todman describes a personal experience with lack of community trust, where the person she connected with said they were risking themselves by even speaking to her, and Beach describes observing doctor-patient interactions where respecting patient autonomy did not protect against disrespectful treatment.
Clinicians’ doubt of patient descriptions of their problems and needs are higher for Black and women patients. And if a patient senses they are not trusted, then they no longer trust — trust is a two-way street.
Should health systems be trusted? It’s a tough question.
Shifting patients toward trust when their narrative context is largely not to trust health systems is difficult. Clinicians need to shift the narrative: it’s a rational behavior not to trust if historically there has been a problem.
Clinicians need to think more carefully about the language they use and what assumptions they make, and may be open to change once they are made aware of the issues. Putting stigmatizing language in the record has a downstream effect of change. Also, what you measure you pay attention to, and there are ways to measure trust and respect.
Dive into the event archive for Social Needs and SDOH: Impact on Patients & Communities and read the related special SDOH theme issue.
Lynn Todman and Mary Catherine Beach have nothing to disclose.
NEJM Catalyst Innovations in Care Delivery
June 12, 2023
Copyright ©2023 Massachusetts Medical Society.
Published in issue: May 1, 2023
Published online: June 12, 2023
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