Building Treatment Trust with Skeptical Patients
To build trust with skeptical patients, explicitly affirm your commitment to supporting them regardless of their treatment choices, demonstrate competence through honest communication, and actively validate their concerns through empathic responses. 1
Core Trust-Building Strategies
Establish Rapport Through Active Engagement
Before each encounter, prepare mentally by reviewing the patient's medical information and anticipating their needs and emotional responses. 1 At the beginning of conversations, explore what the patient already understands about their condition and collaboratively set an agenda after inquiring what they wish to address. 1 This demonstrates respect for their autonomy and reduces the power differential that often fuels skepticism.
Demonstrate Competence and Caring
Verbal expressions of clinician competence, honesty, and caring are directly associated with increased patient trust. 1 Patients assess trust through both technical competence (often judged by reputation or interpersonal cues) and interpersonal competence, with the latter being most commonly reported as critical. 2
Key behaviors include:
- Listening actively as a central focus of demonstrating care 2
- Providing clear, understandable information in small chunks and checking understanding frequently 1
- Answering questions honestly and maintaining good relations 1
- Showing patients their lab results and explaining what they mean 3
Respond to Emotional Cues with Empathy
When patients display emotion through verbal or nonverbal behavior, respond empathically rather than minimizing their concerns or changing the subject. 1 Ask patients what they are most concerned about and explore what is behind strong emotions (e.g., "Tell me what you are worried about" or "What has been the hardest part of all this for you?"). 1
Provide reassurance to patients early in the relationship to reduce anxiety and vulnerability. 3 This might include statements like "I will do everything I can to support you" or "It's my job to help you get the best care possible." 1
Specific Actions for Skeptical Patients
Address Autonomy and Control
Reinforce that the patient will not be abandoned, regardless of their treatment choice. 1 This directly addresses the fear underlying much skepticism—that disagreeing with recommendations will result in rejection or substandard care.
Tell patients it's okay to ask questions and normalize requests for second opinions. 1, 3 This demonstrates confidence in your recommendations while respecting their need for verification.
Provide Transparent Information
Give understandable information explaining the purpose of proposed treatment, expected benefits, and significant risks. 1 Present information in multiple formats (words, numbers, ranges) and use mixed framing (e.g., chance of benefit and chance of adverse effects). 1
Inform patients of treatment alternatives and assist them in making choices by providing unbiased information on advantages and disadvantages of each option. 1 Frame treatment options in the context of the patient's goals rather than your preferences. 1
Avoid Judgmental Language and Behaviors
Avoid language and behaviors that are judgmental of patients. 3 Skepticism often arises from previous negative healthcare experiences where patients felt dismissed or criticized. Maintaining a non-judgmental stance is essential for rebuilding trust.
Acknowledge Uncertainty
Acknowledge uncertainty when it exists rather than providing false reassurance. 1 Patients view trust as an iterative process and commonly test physicians against their knowledge and expectations. 2 Honesty about limitations builds credibility.
Common Pitfalls to Avoid
Do not provide information when patients are in a strongly emotional state, as they often have difficulty absorbing and processing information. 1 Instead, address the emotion first, then return to information-sharing when the patient is more receptive.
Avoid trying to reduce patient distress by minimizing bad news or changing the subject. 1 This erodes trust by signaling that you cannot handle difficult conversations or that you prioritize your own comfort over their needs.
Never allow the choice of treatment to be influenced by your preference or desire to gain experience. 1 Skeptical patients are particularly attuned to conflicts of interest, and any perception of self-serving recommendations will destroy trust.
Practical Implementation
Ask patients what they want in terms of treatment goals and preferences. 3 This simple action demonstrates that their values matter and that treatment will be tailored to their priorities rather than imposed upon them.
Include family or caregivers when possible and acceptable to the patient. 1 This provides additional support and witnesses to your commitment, which can help validate your trustworthiness.
Document discussions in the medical record. 1 This demonstrates accountability and ensures continuity if the patient seeks verification from other providers.