Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


trust “Trust and Recovery”

“The dictionary definition of “trust is an assured reliance on the character, ability, strength, or truth of someone or something; one in which confidence is placed.”   

That is what we request, require and expect a patient to experience.  The patient is seeing you because s/he trusts that you are invested in the rehabilitation process, that you have no conflicts of interest, and that your sole investment and accountability is to the patient.

In the case of injured worker, and now even in the case of private care, the use of procedures, the prescribing of care, the ordering of tests and frequency of visits is determined by a range of people from employers to insurers to laboratories to pharmacies…and it goes on and on.  In private care, your employer may have a new insurer, a new panel, and your willingness to go “out of network” is tested.  

This is not uncommon:   “If you saw Dr. Xxxxxx for five years, and you were pleased with care in that office, why have you stopped seeing him?”   Answer:  “My company changed insurance plans, and he is not in the network.” 

In days of yore, back when leaches and blood-letting were treatments of choice, people made house calls, and you had a family doctor, referring to others as situations demanded, but always professionally, and often personally, involved. 

Today, your private insurance has a panel, determines a co-pay, and the front office serves as a reminder that this is more of a billing operation than a personalized delivery of health care. The relationship with the insurer exceeds the provider’s personal involvement with you and your family.   

In past times, you had “trust” in your doctor.  Sometimes you were given medication samples, sometimes you were given a prescription for an extended period of time with numerous refills; it was efficient.  No longer is that true.

In Workers’ Compensation today, and increasingly as we move forward, after your injury, you are sent to occupational medicine.  You have the impression that examinations and tests ordered may be cursory (cost contained). And in some settings, you may not see the same provider at successive visits. If your symptoms do not resolve, it may take extended days, weeks… for you to be referred to a specialist   This erodes trust.  You interpret the delays as being a financial measure.  You fear you have become “a chart” and a “case number.”  And your experiences consistently tell you that this misapprehension is accurate.

So here’s the real concern:  Does the nature of modern care diminish the probability of a trusting bond being formed?  And if trust is not established, can we expect the patient to comply with directives?  Will the patient take medication, engage in rehabilitative or health behaviors if patients do not trust their providers.  

“He spends 15 minutes with me, prescribes these medications which have very unpleasant side effects, and if I complain, he changes medication or adds additional. Does this doctor even understand what is really wrong with me?  I have not told him everything, and with these brief visits, I do not feel that I ever will.”

The probability of recovery is negatively impacted by the lack of trust that would bond together the patient and provider. 

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