Dr. Neil Sikka answers questions about digital health technology.
Qualcomm
The theme of the recent American Board of Internal Medicine (ABIM) conference was “Being a Trustworthy Expert in an Untrustworthy World.” Trust was the theme that punctuated each conversation, including the keynote address by CVS Chief Medical Officer Sree Chagtur. He spoke of the organization's deep commitment to building community trust while addressing the challenges associated with proving a tangible and direct link to economic benefit. This is not a new challenge. Many people in the healthcare ecosystem recognize the power and importance of trust to most things in healthcare, including engagement with and adherence to health advice. If trust is widely and intuitively accepted as essential for better outcomes, why can't we prioritize and measure it? At the conference, nurse and former ABIM Board member Jackie Judd asked a provocative question about trust in health care. “Is this problem too big to fail, or too big to solve?”
it depends.
If the goal is to achieve a return on investment (ROI) without much regard for patient and community benefits, it is probably too big to fix. But if the goal is to ensure high-quality, high-value care for everyone, this issue is arguably too big to fail. why? You can't maximize ROI without patient engagement, and you can't optimize engagement without trust. But the challenge with much of our reflection on trust in health care is that our reflections on it are too mundane. Trust seems like an obvious thing that needs to be mentioned in conversations about health equity and the social drivers of health. But it's much more important than words.
A few years ago, while answering questions at a homeless shelter, one of the residents asked me: I don't like it because I don't understand it. If I don't understand what you're saying, I can't trust you. ”His medical support was a combination of Google and the emergency department.
Recently, while I was chatting in the community and answering questions from passersby, a woman who had been watching me for quite some time came up to me and handed me a banana and asked me to eat it while she watched. I asked. I agreed on the condition that she explain why she insisted on eating the fruit on the spot. She said, “We want to know if you trust us.” She wanted to know if I would see her as an equal and treat her with dignity and respect. She wanted to know if I understood her humanity as much as I understood her own. After that exchange, we were able to have a conversation.
These stories provide important lessons about why it is essential to “repair” trust in health care.
First, while trust may not be easy to measure or assign quality standards, it pervades and influences every engagement. Second, people expect us to provide them with the same level of respect and consideration they expect when receiving service. When I talk to lawyers, accountants, and auto mechanics, their approach will determine whether they can solve my problem honestly and fairly. I expect plain language communication to ensure that I understand my options and potential actions. Why should healthcare be different? Thirdly, in plain language, our communication must reflect the needs of the other person. This seems infuriatingly obvious, but it doesn't happen all the time. At least every week someone contacts me, whether it's a friend, family member, or friend of a friend, asking for an interpretation of something the doctor said while using medical jargon they don't understand. We need to train our students, interns, and residents (the healthcare workforce pipeline) to speak plain language.
Finally, we must prioritize trust as a driver of health outcomes and detail the ROI opportunities for addressing it. For example, how does trust affect early care and medication adherence? What are the costs associated with clinic “no-shows” and avoidable hospitalizations for people with assigned primary care providers? Whether we recognize it and address it or not, trust lurks in the background, showing up in balance sheets, quality metrics, and health outcomes.
At every health-related conference, I imagine someone, somewhere, is stressing the need to build trust in health care. Let's hope these discussions move from the podium and boardroom to the C-suite and boardroom. After all, if trust in health care is truly too big to fail, strategies to fix it will need to start there.
