Dr. Kevin Most: Trust of Physicians
What Dr Nassar did to these young women words cannot describe. My thoughts reach out for those young women who were strong and stood up to tell their story so he would not be allowed to harm another patient as he sits in jail. It is important that we discuss what we need to do, if a professional ever abuses the authority or trust that has been extended to them thru their profession. We must have more step up and raise a concern if a question arises.
The field of healthcare is a sacred profession. It is probably the only profession where trust is extended to you before you earn it from your patient. This trust has been extended by patients because of the history of the profession, the training we all get and the responsibility handed to us from generations of those who served before us in healthcare. You trust us with your lives, with the lives of your children and your loved ones and we, as physicians take that duty very seriously. We honor and protect that, for you as a patient, as well as for the physicians who will come in our footsteps and will be caring for generations to come.
That trust is needed in order to provide the best care while maintaining confidentiality and working to improve the health of all
It is very unfortunate when one in our profession violates that trust. That violation hurts us all, it hurts the profession to know that someone has harmed individuals when our basic tenant is to do no harm. It hurts all patients as the slightest thought of uncertainty or mistrust can impact their care. It also impacts the future of the profession as a small portion of that extended trust has been eroded by a single individual who delivered harm and eliminated that bond.
All I can say is patients can continue to place their trust in the healthcare team that treats and protects them, the actions of one individual should not taint the entire profession. That being said we need to realize we live in a time where questioning a physician is not only ok, it is expected.
We want individuals to ask, Why?, we want them to understand what is going on their body. The individual who understands their condition is more likely to have a great outcome. They are more compliant with medication and treatments, when they take the time to understand the “Why” around a medical decision. Every patient should have the option to understand their disease and their treatment plan. When they don’t, the questions asked should be welcomed and answered at a level that is understood. The diabetic does not need to know the science behind glucose, insulin and cell metabolism, however they should understand what a high glucose level will do to their eyes, kidneys and heart. If a treatment or exam does not sound right, ask, Why are we doing this? What do we expect to learn or gain from this?
Parents are and always should be protective of their children. Parents are protective in the home, in the neighborhood and in school setting. The medical office should be no different. Making sure the young child understands what is going to happen is important on many fronts. The child deserves to know in some part what is occurring and why, explanations need to be extended at a level they will understand. That explanation should make sense to both the child and the parent. The child will look for reassurance and expect protection from their parent. Now sometimes we allow the child to have a little too much say and in those cases we need to do what is right and explain to the parent what we are planning to do and why. The parent at that point can make the decision.
We all know there is a time when a child hits an age where they do not want their parent in the exam room , it happens sooner in some children than others so the age is tough to outline. That being said having a clear understanding with the physician before the exam as to what it will entail in front of the child, before the adult leaving is crucial. It allows for a few things, one it allows for the child to understand what is going to happen and then have a decision if they want a parent there. Two it allows the parent to ask questions about the exam, educating both themselves and the their child. Finally that discussion has set the guardrails for the exam and the child will know if those guardrails have been followed.
The physician is responsible to also educate and give an opportunity to have a discussion with a child about some sensitive topics. Often this is best done with a parent not present. A child is more likely to tell a doctor that he has been bullied or has been offered drugs than he may his parents. We often take this opportunity to discuss peer pressure, drug use, tobacco and sexually transmitted diseases. Children often need this time to ask a question or clarify a concern or false comment that has been made by another child. Physicians often will reassure the child and recommend notifying the parent if anything occurs. The physician actually acts a liaison in this position to let the child know it is good to let their parent know about issues.
This also allows for the parent and child to talk later and keep open that discussion of health and peer related issues.
Being honest with a child again allows trust to grow. Before putting stiches in a child we often need to give them a shot to numb the area, the shot hurts and sharing that with the child is important. If we say this won’t hurt and it does, that child now has no trust in us. We are expected to treat everyone with respect and children are no different, building a bond of trust with a child allows for cooperation thru the exam and treatment and leads to better outcomes.
We are blessed to be allowed to practice in a profession that has the close personal bonds that we are allowed. A single individual shattering that trust and that bond reminds us all how special it is, how we must hold on and protect the relationship. The trust and bond were given to us by our preceding physicians, we did not earn it they did and it is only ours to protect until we hand to the next generation of physicians.