In medicine, trust needs to be built in a matter of minutes

From KevinMD.com

Written by Scott Finkelstein, MD

I was a very shy child. I never felt comfortable speaking up, especially in groups or in new situations. When asked a question in class, my heart raced, my eyes teared up, and I felt sweaty. As I grew up, these physical reactions subsided as I learned to internalize and manage this fear. But at that time, I could not have imagined that my professional career would depend upon my ability to meet dozens of complete strangers each week, engage them in conversation, and get them to trust me with their lives — in less than ten minutes.

As an anesthesiologist, I deal with life and death situations on a daily basis. I have cared for a three-hour old infant with gastroschisis who needed her bowels emergently replaced into her abdomen, immediately followed by a severely ill elderly man in cardiac shock, dying from a massive heart attack. Caring for patients with critical illness at the extremes of age has taught me many things.

I have learned that life is not fair. Some of the most wonderful people have been afflicted with the most awful medical circumstances. In my experience, each child who is diagnosed with cancer has the sweetest, most gentle soul imaginable, and their families are uniformly amazing. This happens so often, that I have classified “being too nice” as an unofficial (and non-evidenced based) risk factor for developing horrible diseases.

I have learned that despite my best efforts, there are times that I cannot save a patient. No matter how many drugs I use, no matter how many invasive monitoring devices I place, no matter how many blood products I give, some patients just cannot be saved. This has been a hard lesson to learn, and even harder to accept, but I carry each of these experiences with me, as motivation to continue on no matter how bleak a clinical situation might appear. With a coordinated team effort, and often a little luck, we are able to save patients who might not have survived otherwise. And although these circumstances are rare, it reminds me of why I became a doctor in the first place.

Most importantly, I have learned that I am no longer that same shy boy who had trouble speaking up in class. I have found my voice, and I know how to use it to make my patients and their families feel at ease before what might be the most terrifying or nerve-wracking day of their lives. I advocate strongly for my patients in the operating room, to ensure that their best interests and wishes are always protected. I can give them a voice even when they are unable to speak for themselves.

Being an advocate for your own health care, or for that of a loved one, can be very challenging. During the peri-operative experience, patients and caregivers can be overwhelmed by the myriad of staff they meet, the invasive procedures they may undergo, and the concern that something might go wrong. But despite all of these worries, when I ask my patients if they have any questions or concerns, many of them say, “Probably, but I don’t even know what to ask.”

Building trust is not easy. It is typically earned over time, through shared experiences and tests of loyalty. In medicine, and in the field of anesthesiology in particular, the luxury of time is unavailable. Trust needs to be built (and earned) in a matter of minutes. And perhaps this is what makes surgery such a daunting and scary concept for most patients. Going under anesthesia removes all control from the patient, and places it in the hands of someone who was a complete stranger just a few minutes earlier. This acquiescence represents a leap of faith that even the most trusting souls can be wary of.

Given my overwhelming shyness as a child, I find it ironic that these new interactions have become one of the highlights of my job. Now, I love to meet new people every day. I am honored to be there for patients during this scary and vulnerable time in their lives. I know that I can make a difference. I give each patient my full attention. I maintain eye contact. I listen. I validate their feelings. I answer their questions. I educate. They understand. The fear melts away. And then they trust me. All in less than ten minutes.

Scott Finkelstein is a pediatric anesthesioloigst and chief medical officer, Consano.