Trust me! (no explanation required)

In Commentary, Opinion by Nadim LalaniLeave a Comment


Two stories:


Yesterday I had a patient come to the ER because she didn’t trust the family doctor she had just seen at the clinic who

“gave me a prescription for puffers worth hundreds of dollars without even listening to her chest!”‘

I did my usual and diagnosed the child with reactive airways (likely asthma due to positive family history) … I told the parent that I agreed with the original diagnosis, but apologised for my colleague who, although correct, didn’t inspire confidence with her approach.


Yesterday I also received a panicked email from an old acquaintance who’s getting the run-around with her one year old who keeps getting put on antibiotics for Otitis – antibiotics that don’t work. Antibiotics that gave the child a rash and now she could be “allergic to cephalosporins and so shouldn’t take amoxil”. To make matters worse the pharmacist questioned the prescription for codeine. In all this time – no one had taken the time to EXPLAIN things. She was trying to figure it all out on the ‘net and, frustrated, looked me up and sent me a ‘hail mary’ email hoping that someone out there could answer some basic questions honestly and without evasion.

It took a couple of emails, some spiel on antibiotics for only proven diagnoses, confirming some literature on cross-reactivity of cephalosporins with penicillins and explaining why we write codeine for ear pain … (insert calm, placated and eternally grateful formerly-panicked parent).


I have blogged before about physicians engaging in really dastardly things that erode public trust. This is a nasty epidemic facing our profession and there’s an abundance of literature on it. But not-so dastardly things erode trust too – like POOR COMMUNICATION. Here’s an excerpt from Alice Jacob’s article in CIRCULATION on Rebuilding Trust:

“Interpersonal competency refers primarily to our communication and relationship-building skills—listening, understanding, providing complete and honest information, and showing you care—as so genuinely expressed by Frances Peabody. Increasing competency is important, but it alone will not restore trust. Patients don’t necessarily care how much you know until they know how much you care. So, in the future, we must ensure that healthcare professionals have both the technical and people skills necessary to be effective…

I am not a saint. I am also guilty of not communicating effectively at times [usually busy night shifts when I am trying to get to the next case]. But I like to think that I can learn from my mistakes. So here’s my reminder [to myself and others].

An ounce of prevention is worth a pound of cure … (or better yet) … an ounce of explanation is better than a pound of obscure!

Often you need to pause, take a breath and take the time to explain things:

  • Explain like you really care.
  • Explain your rationale for treatment/no treatment.
  • Explain how confident you are in your diagnosis.
  • If you’re doing stuff that might be out of keeping with patient expectations – [e.g. deferring a resp exam] explain why.
Nadim is an emergency physician at the South Health Campus in Calgary, Alberta. He is passionate about online learning and recently made a transition into human performance coaching. He is currently working on introducing the coaching model into medical education.