FiercePracticeManagement has dedicated a lot of space to the need for physicians to build trust with patients and employees. Often characterized by their brusque or insensitive manner, doctors have been placed so far on the defensive that we've even presented advice to help them prove they're not jerks.
But as some of the coverage in this week's issue reminds, doctors get lied to and taken advantage of all the time. They fall for fake patients exhibiting fake pain. They get robbed of thousands of dollars by their own employees.
Does this mean that doctors are suckers? Of course not. Like all human beings, some physicians might be more blind to dishonesty than others. But, in general, the "problem" is that by the nature of such a giving profession as medicine, doctors simply want to believe in the people they're trying to help. As a recent Harvard experiment showed, when physicians observe expressions of pain in the faces of patients (even fake ones), their brains perceive that pain too. When they provide a cure--or believe they do--scans show doctors' brains light up with relief.
In a perfect world, everyone's default setting would be to trust and be trustworthy.
It's not wrong to trust or feel empathy. It may be a double standard. Just as it is physicians' role to build rapport with patients, the onus is also on them to detect and guard against others' dishonesty. Rather than having to play detective or mind reader, though, experts recommend that doctors put blanket safeguards in place to make deception harder to pull off.
When it comes to embezzlement, for example, the key to prevention is not giving employees the opportunity to steal. Background and credit checks are an important part of the hiring process, but statistically, most practice thieves are first-time offenders desperate to solve an unexpected financial emergency.
At its most basic, your theft-prevention strategy needs to be based on treating everyone as a person with the potential to give into temptation. Rotate their duties, and check up on their work. Take a general interest in how their lives are going outside of work. These are basic protocols that are all-too-frequently skipped. But don't look at these steps as an expression of mistrust, but more as a means of protecting everyone from the possibility of falling into a trap that could be just as dangerous for them as for your practice.
The problem of discerning truth-telling in patients may be even more difficult, especially regarding symptoms, such as pain, that are subjective. In reality, though, when a patient says he or she is in pain, it most likely is the truth. The pain may not be physical. The real reason a person may be seeking medication may be depression or financial desperation or an existing addiction.
Diagnosing these root causes is not easy, but it's critical. Just as you wouldn't treat appendicitis with a BandAid, even if your patient begs for a BandAid, you can't treat most nonphysical problems with medicine at all.
All you can really do is try your best to know your patients--a tall order given today's hurried health environment. But at least encourage an annual physical even with patients with no glaring health problems, and note any differences in a person's demeanor that emerge year over year. With new patients, rely on your intuition and years of experience to pick up on clues that something is amiss.
By the same logic, invest in relationship-building with your employees. Use your most important instruments--the ability to listen, communicate and observe--to nurture these relationships through good times and bad.
I'm curious to see what strategies those of you working in practices recommend for building two-way trust between doctors and the people they interact with. Have you been deceived by patients or staff? What lessons have you learned? Please share your insights and strategies with your peers. - Deb (@PracticeMgt)