The importance of trust

Mary Leigh Meyer: Howdy, welcome to Sounds Like Health. This is Mary Leigh Meyer.

Sam Craft: And I’m her cohost, Sam Craft.

Mary Leigh Meyer: And we are here today with Dr. Matt Hoffman. This is his second time on the show.

Sam Craft: Yay!

Matt Hoffman: Hi, thanks for having me back.

Mary Leigh Meyer: He’s with the Texas A&M College of Nursing. Welcome.

Matt Hoffman: Thanks for having me; I’m excited to be back.

Mary Leigh Meyer: And we brought you here to talk about how important a trusting, honest relationship is with your health care provider.

Matt Hoffman: Absolutely. It’s really important for so many different aspects, and I think that there are some times, people sometimes believe that maybe I can’t ask questions to my provider and that it’s a one-way relationship. But it’s definitely two way in terms of we want to create a two-way communication and trusting relationship where you feel you can trust us and we can trust you. And that’s even a big part of how we are educated as clinicians in terms of our approach and understanding different approaches that people might already come to the table, or to the exam room, with.

Sam Craft: Well, it’s not just your provider. It’s the people at the office, it’s the lady at the front desk, or it’s the nurse that comes in before the doctor. And they always ask hey, I know you’re here for a checkup. Is there anything else that’s going on? And I think it’s scary, not to offend them or their knowledge, but just that’s not my doctor. I don’t wanna get into that conversation. But what’s the other side of the coin when that nurse comes out of that room, and that doctor comes out, or whatever? What’s y’alls conversation in the hallway like?

Matt Hoffman: Yeah, it’s different in each different setting, but you bring up a really good point in terms of we have what, unofficially, we refer to as gatekeepers. So, the person that answers the phone to take the appointment or the person that is maybe bringing back the patient and getting those vitals and then getting just the basic scenario. That really does end up being an aspect where they’re trying to help facilitate our day, maybe help us try to narrow a diagnosis, or just really give us the big key points that have been shared with them because, again, someone might trust the medical assistant more than they do the provider. So, it may be easier to talk to them than the other person that’s gonna come in the room later on and do the prescribing. So, one of those aspects is really, really important is, regardless of who it is, try to actually share the same information with everyone in the office, just depending on your comfort levels. And there are different instances. And, again, we’re taught as clinicians about why different individuals may or may not want to share information. And it even goes back to the theories of what your perception and idea of health is and how often you need to be seen. And if people have general mistrust of the health care system, those might be more hesitant to seek care or get routine care and maintenance, which is so important, and we’re really pushing that now. But the perception may be that, oh, they just want me to come in so that way I can give money to insurance or meet my deductible or something along those lines. But, again, it’s really that trusting aspect of that’s really not why we need you to come back in. We’ve got to talk about these labs, or we’ve got to talk about some aspect to keep you healthy in the long term.

Sam Craft: Have you ever had a patient come in with one thing and then it just seems that you’ll say, hey, come back and see me in six weeks, and this has changed into something else, and then three weeks it’s into something else? And they don’t, I guess, they understand fully what’s happening, but you, as a provider, can see that, internally, hey, this is an issue that’s growing and growing. And, just like you said, they fight you in coming back like, why do I keep coming back to you?

Matt Hoffman: Right. When that happens, it’s best to be as transparent as a provider as you can in terms of saying this is what we’re going to need to look for. So, I do that as best I can, and I think that’s the nursing process as well. We’re taught to do education along the way and what to expect in terms of the disease process. And, as a clinician, that’s what I also do in terms of if I have to start somebody on a new blood pressure medication. I let them know there are going to be a series of follow-ups from this point forward because I have to make sure that this works well for you, that you don’t have side effects, that we’re not changing it too low, and that does take several months. So, once we get to that happy spot where the blood pressure goal is met, the medication is working the way it needs to, then we can have a larger break before I actually have to follow up again specifically for that blood pressure issue.

Mary Leigh Meyer: That’s something that I think is pretty important, and a lot of people don’t understand is if your provider is prescribing you a medication and you don’t understand why it’s going to help you or how it’s going to help you, then ask. It’s okay to ask.

Matt Hoffman: Right.

Sam Craft: And some people not knowing. For example, I have my blood done every six months ’cause of a medication I’m taking. It varies. They change it every time. And I didn’t know that when I first started taking it. I just thought that once it was set, it was set. But I think that’s interesting.

Matt Hoffman: There are so many variables that go into it, especially with chronic diseases and chronic conditions like blood pressure and diabetes. We want to do and create a mentality of generating some sort of change and improvement that’s beyond a pharmacologic approach. So that might be weight loss, increased activity, something along those lines. And, in both of those cases, if individuals really stick to it and have significant weight loss, we actually can sometimes take people off of their medicines. So that’s exactly why we have to follow up. Sometimes it’s not able to happen, but, ideally, we actually don’t want people on medications if they don’t have to be.

Mary Leigh Meyer: If you’re going to see a new provider, how do you build that trust? Is there any way that a patient can form that relationship? Because those visits, sometimes, are only 15 minutes…if that.

Matt Hoffman: Actually, yeah, there are several ways. One of the things that I like to do is talk to people. So, if I move to a new town or place, I ask about providers and find out a little bit more. Why do you like them, what is it about them? And then also, you can call the office staff and just talk and just get a general idea and background. There are websites out there that just give you some basic, general demographics about the providers, clinicians, as well as some ratings scores. If you have friends that have been going to someone for a very long time, find out why. There’s likely some reason for that longevity, and it might be a good fit for you as well. But we’re seeing health care as a consumer’s market where you’re getting those ratings and people and systems are being held accountable for really good quality service. So, looking at that, it’s another thing that’s really projecting people and prompting them to do a little bit of shopping, looking around, and getting a lot more information. But in that initial visit, it actually might be a good idea to say how you heard about them and what it is because there are some people that only want a provider that’s going to just get to directly to the point, no conversation. Just let me come in and see you for 15 minutes and be on my way. But then there are also the others that want a more conversational encounter and spend more time with the provider, and I’d like to think that’s the kind of provider I am, even though I do have scheduling. But I may not be a good fit for somebody that just wants to come in and out, so…

Mary Leigh Meyer: Can you ask that question? You mentioned you can call and ask about their practice. Can you ask what is his or her…

Sam Craft: Like their demeanor?

Mary Leigh Meyer: Demeanor, yeah.

Sam Craft: I don’t know. I think, if I were a provider, I might be kind of offended if you called and asked me that. I think some people would take it the wrong way.

Matt Hoffman: I think that that’s a really good point because it is a bit of an unorthodox question to receive ’cause, again, remember you might be calling in and speaking to a receptionist and never speak to a provider.

Mary Leigh Meyer: And, of course, they’re gonna…

Matt Hoffman: They’re gonna have a…

Mary Leigh Meyer: …say “oh…

Matt Hoffman: …little bit of a biased…

Mary Leigh Meyer: “…they’re wonderful.”

Sam Craft: They might have even been there two days and not even know how to answer your question.

Matt Hoffman: That’s very fair, good point.

Mary Leigh Meyer: But that’s important, that you need a provider that matches you.

Sam Craft: You explained it the best is, when you move somewhere, find your people and ask them who they’re using. That’s how I found my doctor here in town was that I asked my boss. I was like hey, I need a doctor. And I’ve been with my guy for four years and he’s wonderful. It’s a great thing.

Matt Hoffman: And, to that point, if you do end up finding someone that’s not a good fit, it is not going to hurt our feelings if you go somewhere else. It’s actually, especially in the beginning when you’re trying to find a provider, keep shopping until you find the one. And I tell people that about whether it’s primary care, it’s very important with therapists and counselors as well. But make sure that it’s someone that you’re comfortable with and that it’s gonna be someone that you can always talk to and feel good about walking in the door.

Sam Craft: Well, and as a patient, I think once you have that with somebody, you really will open up with them. Hey, this is what’s going on. It’s embarrassing, I don’t wanna talk about it, but you’re my guy or my woman, whatever, so we’re gonna talk about it. From a provider’s perspective, how do you get patients to open up to you? If you’re in a room, and you know something else is wrong but you have to get it out of them, how are y’all trained, or how do you personally deal with that?

Matt Hoffman: There are several parts, ways, to answer that. The easy answer is it takes time to really develop that demeanor because I like to be casual. And, really, for me to be casual and comfortable, I believe, emits a casual encounter. However, there are some people that don’t want a casual demeanor. So, it really is almost like a blind date, especially whenever you’re seeing someone for the first time to see what the chemistry and the dynamic is. And sometimes, I won’t necessarily be my casual self after the first couple of visits until we really have established that relationship a little bit more strongly. So, time is definitely one component of how we do that, but, really, in terms of getting to the bottom of certain issues or if there is something that we believe is going on, we do sometimes have to be direct in terms of is there anything going on. And there do tend to be topics that lend themselves a little bit more to that timidity of someone either bringing it up, something along the lines of interpersonal violence or something along those lines at home. Additionally, depression is another thing.

Sam Craft: Yeah, I would think that’s a big one. There’s such a stigma around depression, and I think people are afraid to talk about it.

Matt Hoffman: Absolutely. So, it’s one of those things where we have ways, and we even have screening tools that are oftentimes used at practices to just get a baseline to see where an individual is. But I personally always, if I feel there’s something that I need to get to but the person doesn’t necessarily feel forthcoming, I just reinforce this is a safe place, everything you say in here stays in here, and if it’s not an issue, great. And if it ever does become an issue, know that I’m here to help you.

Mary Leigh Meyer: What about those topics that are a little bit more embarrassing in nature? I feel like that’s a lot of where this…not a miscommunication…but lack of two-way communication can come in.

Matt Hoffman: Sure.

Mary Leigh Meyer: Is there any advice you would give people in that type of situation?

Matt Hoffman: Absolutely. I think that the best approach is to identify, as a patient, what it is that makes you uncomfortable. So, I’ve seen, personally, where my female clients might not necessarily want me to take care of their well woman visits or their pelvic exams. And that’s okay. We have a female provider in the office that will take care of that. But some of my female clients aren’t bothered by that. So, it’s one of those aspects of if you know that you would be more comfortable with someone of the same gender or opposite gender, that may be the only obstacle, and then you can just open up and do your thing, have the conversation, and talk about whatever needs to be discussed. I’m happy to give referrals out to individuals, especially in terms of OB-GYN care. If you’re going to be family planning at some point in the future, go ahead and establish care with someone else because they might be able to assist you later on down the journey.

Sam Craft: The gender thing was a good point. I had to go to a urologist one time, and I had a male doctor who saw me to begin with, and I ended up having kidney stones. And after the process was done, he handed me off to the next doctor at the clinic ’cause he had something else. But it was his daughter. And I was instantly like…

Matt Hoffman: Yeah.

Sam Craft: …it’s urology…I’m a dude. It was a weird feeling for me. It was just like what you talked about. I don’t think people realize, sometimes, that there is an option to ask for somebody else in the office to come do that or even just to talk to. It’s like hey, I need to talk to another male doctor, if that’s okay because if you’re a guy and you have ED or something along the lines of below the belt, it’s a pretty touchy subject to talk about with a female that you don’t know. And you might be really embarrassed about it. And maybe guys can relate better or whatever.

Mary Leigh Meyer: But you would need to set up your appointment like that, right?

Sam Craft: I don’t know.

Mary Leigh Meyer: You can’t just go into…

Sam Craft: Could you just, while you were there?

Mary Leigh Meyer: …set up an appointment and ask?

Matt Hoffman: So that’s a really good point that both of you bring up. So, you’re right, Sam, in that it is absolutely an option to say I’d rather, let’s time out. I’d rather have this conversation with a male provider. We’re not going to get our feelings hurt because, again, we have your best interests at heart, and this needs to be, as long as it’s not something urgent and immediately needs to be addressed, we’re gonna be happy to let you see another provider. But it may need to be another appointment, like if he’s not available to see you today, you’ll have to reschedule for some other time. As long as you’re comfortable doing that, and, again, I have to emphasize, and it’s not an urgent medical need that needs to be addressed, then absolutely. Just rescheduling for a follow-up so that way you are comfortable and that you have enough time to adequately address whatever your concerns are.

Sam Craft: And I think on the same coin, you could say that the famous book that’s out there, it says everybody poops, is like every doctor, I think, has seen everything. And it’s like for a patient to come in and be timid and be nervous, as professionals are used to, I’d say, everything in the book, at some point in your career. So, it’s like is it weird to see somebody have a stigma?

Matt Hoffman: Not at all. We have seen so much, and we’ve been trained to recognize and identify some of these elements that might be discomforting to individuals. And so we’re already aware of some of those topics and those issues, and we are even trained to be able to identify and maybe seek out, if there is something concerning or a taboo topic, we’re able to handle all of that. So even down to the receptionists, there’s training that takes place. They are bound by the same laws to keep information private unless there’s a need to know aspect. And so it’s okay to share that information to make the appointment, even though it may be embarrassing. I would even say just maybe practicing exactly how you want to say what the issue is before even calling might be something that could help bolster someone’s confidence in maybe approaching one of these topics.

Sam Craft: Matt, talking about trusting your doctor—your provider—whoever you’re going to see for your medical care, I have a four-year-old growing up, and he’s a little kid, so he’s terrified of doctors. And I don’t know at what point in my life where I started to trust my doctor. I don’t remember when that was. But I didn’t have that advice growing up from my parents. They weren’t negative about it, they just didn’t say hey, this is your doctor. You can talk to them. This is your provider; talk to them. What’s your advice to parents to their children about providers and healthcare and as far as hey, something’s wrong, tell somebody?

Matt Hoffman: Yeah, that’s an excellent question. This is another thing that we are trained on. So, we recognize the developmental approach that we have to take based on the kid’s age. And it can be something as simple as not making eye contact because the eye contact will actually scare them a bit more. A lot of the things I do is I really love it when parents can bring their kids in with them for visits because they can see, look, it’s not scary for Mommy or Dad to get a stethoscope on their chest. And, oftentimes, I’ll let the kids play with my stethoscope or let them listen to my heart and lungs so that way they see this is not a scary device or anything along those lines. I also love that there are now toys and things out there so that way kids can play with these at home. And it’s breaking this stigma that this is only something in one setting.

Sam Craft: Yeah, you shouldn’t be scared of it.

Matt Hoffman: Exactly, and to your point about trusting as well, there’s a whole lot of education that parents are doing out there with stranger danger and all of those aspects. So, this is definitely a scenario where it’s okay, and you want the child to know that your doctor, your provider may actually need to see you with your shirt off. And so, if they ever ask to take your shirt off or ask you to take your shirt off, it’s okay. You also have the right to have your parent present. So, if you don’t feel comfortable, ideally, we’re always going to have a parent present. But we also get to the adolescent age where we sometimes have to ask the parents to step out. And it’s one of those aspects where, if we already have that trusting relationship, it makes it so much easier for a parent to walk out the door and leave their child or their adolescent…

Sam Craft: I think, for the parent, too, mentally, that’s a good point is having the trust in that provider to leave your child with them.

Matt Hoffman: Absolutely.

Mary Leigh Meyer: And know that your child understands what is…

Sam Craft: That they’re safe and…

Mary Leigh Meyer: …correct, and what’s wrong and why this situation is probably a little bit different.

Sam Craft: Sure, sure.

Matt Hoffman: Absolutely, and I have had a scenario where there was a rash on a child’s torso that I needed to see. And so, when I asked to lift the shirt, the kid paused and looked at the parent, and the parent nodded and acknowledged that it’s okay. And I just thought was excellent teaching to the kid and a good, a positive reinforcement that yes, you absolutely, it’s okay, and it’s safe for you to lift your shirt up in this scenario, so great…

Mary Leigh Meyer: Yeah, the best way to learn is through experiencing it.

Matt Hoffman: Mm-hmm, absolutely.

Sam Craft: Yeah.

Mary Leigh Meyer: And what do you think of patients that walk in with a laundry list? I feel like I always do that.

Matt Hoffman: This is my approach. I definitely know that there might be a love-hate aspect behind that, but I actually appreciate that simply because it’s going to let me know that, number one, you’re invested in your care. But additionally, it’s going to let me know that I can hit all of your bullet points for that visit. Sometimes, if there is a more extensive conversation, even for insurance purposes, we might have to have you come back to address a couple of those aspects. But it lets me know what you’re needing from me and lets me take care of that before I have my hand on the door and have one foot out and saying, oh, by the way, I have, this, this, this, and this.

Mary Leigh Meyer: And I’m sure that helps you plan out how you approach each appointment, too. If thing number four on my list is huge and I don’t realize that, you know we need to spend more time on this versus…

Matt Hoffman: And yeah, thing number four might be related to thing number two that could be fixed by addressing number one. And so, it may be linked, they may be separate, but to know in advance as opposed to on the way out the door would be generally advisable and much, much, much appreciated.

Mary Leigh Meyer: Absolutely. So, I think we need to wrap up. Is there anything else, Matt, that you think we should address?

Matt Hoffman: I think I’d just like to circle back to what I said earlier in terms of my casual approach. If you do encounter a provider that seems casual or maybe a little bit too cavalier about care, again, it’s one of those aspects where you can definitely continue to forge forward or maybe seek another provider. For me, what I’ve seen is that there might be a fear that the person is not serious or a little bit lax in terms of their approach to care. And I never want someone to mistrust my intentions and know my capacity and my knowledge base. So, usually, that does come out of me after I’ve established a rapport and that trusting relationship. But, again, it’s one of those aspects that can go either way where my intentions are to make you comfortable, but I may actually turn people off to that. And so, I wanna make sure that just following up, that we’re just really doing everything to make you have a good encounter.

Mary Leigh Meyer: And it’s okay to shop around, it’s okay.

Matt Hoffman: Absolutely, absolutely.

Sam Craft: Yeah.

Matt Hoffman: If you don’t feel that we are a good fit, if it was an awkward blind date like I mentioned earlier, absolutely no pressure to come back. Find somebody that you’re gonna be comfortable with and you’re going to want to see for years and years and you’re gonna want your family to see, even.

Mary Leigh Meyer: Yeah, I think that’s a perfect takeaway for this whole conversation.

Sam Craft: Know your people, trust your people, tell ’em what’s happening regardless of what it is. Just be honest.

Matt Hoffman: Absolutely. Just make sure that you’re getting your money’s worth.

Mary Leigh Meyer: And I’m gonna be honest now. Matt, it’s been a pleasure.

Matt Hoffman: Yeah, thank you. I’ll be back any time you’ll have me.

Sam Craft: Yay, thanks for coming again. We really enjoyed it.

Matt Hoffman: Thank you.

Mary Leigh Meyer: And thank you all for listening. This has been another episode of Sounds Like Health.


Source: TAMIU Health

The importance of trust

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