August 24th, 2017

Trust in Medicine: From 3 to 83

By Domenic Fraboni

By: Domenic Fraboni

I’m about to share a story about trust that I learned in an unexpected fashion and from the most unexpected teacher. This unexpected master class in trust was delivered by my nephew. Now, why would any possible readers care about me jabbering on about a 3-year-old that none of you know? The reason being: I think the couple paragraphs that follow run nearly parallel to the trust and therapeutic alliance needed to ensure great, patient-centered care. As a future doctor of physical therapy, I have encountered many instances in the patient room that trust is paramount. Someone who has the strength in their lower extremities to stand and walk but hasn’t been up out of bed for two weeks. An individual who has fallen three times in the past year, twice resulting in hip fractures, and they are terrified to get out of bed after their most recent procedure. A patient who has left sided hemiparesis due to a recent cerebrovascular accident and needs to completely re-learn how to ambulate. These are all (similar to) instances that I have personally encountered, and I have not even been in patient-contact, clinical settings for a complete year. Back to my nephew.

The whole crew! Perfect day for a boat ride. PC Emma Tenge

I was lucky enough, just recently, to spend a gorgeous, summer day with my entire “Modern Family” out on the lake. The day was packed with all sorts of festivities including a delicious brunch, pontoon cruising, taking a dip in the lake, and even some tubing behind the boat. However, I am not writing today to tell you another story about my unique family. I learned a vital lesson during this extra humid day out on the Minnesota water. Even more interesting, my teacher was my three-year-old nephew. He managed to sprinkle in a valuable toddler-led seminar about trust among all the lake activities.

Initially, my nephew, Jasper, was terrified at even the thought of going in the water. We slowly worked our way down the boat ladder. As soon as the water got above his knees, he would scurry back to safety. I nearly succumbed to the fact that we would not achieve our end goal of getting him tubing behind the boat. However, we slowly progressed to going in the water up to his waist, then chest, but I could not get him to let go and swim around with me. Hmm…. What to do?

At this age, Jasper is able to understand basic sentences, so I said to him, “Jasper, if you let go of the ladder, I promise that the life jacket will hold your head above the water.” With odds of zipping around the lake on the tube looking grim, Jasper finally let go. The effect was almost instant. Jasper felt the buoyant life jacket holding him up and knew that his precious head was safe from the treacherous water he so adamantly feared. In a matter of 10 minutes, we had him doggy-paddling around the boat, going for dolphin rides on my back, and even blowing bubbles in the water with his mouth. Jasper wasn’t satisfied. After his uncles briefly demonstrated to him that tubing behind the boat was not as dangerous as imagined, he joined us! During the entire ride, he did not tell us to slow the boat down once; in fact, he kept giving the thumbs up to say “faster.”

Look mom, no hands! My nephew Jasper, younger brother Gino, and me tubing out on the lake.

Research completed in 2000 concluded that, although the importance of trust in the patient-clinician room cannot be questioned, much of our understanding of trust relied in large part on anecdotal evidence from enthusiastic physicians. More recent research, done by Street et al, identified “seven pathways through which communication can lead to better health include[ing] increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions.” The pathway that most resonates with me among that list is enhanced therapeutic alliances. This is because some of the most recent research, coming from within the realm of physical therapy and rehabilitation, showed that the patient-therapist alliance can have a positive effect on treatment outcomes. The trends in the research are clear; communication, and specifically trust, can make worlds of difference in your patient’s medical experience and overall quality of care.

Here is my plea to all trainees and current health professionals in the field: Take the extra minute. Be there for the patient and their questions, concerns, sorrows, and fears. Come down to the patient’s level in your delivery of their care. Make sure they understand what is being done to their body and have a voice in those decisions. Yes, this model may take 2, 5, or 15 extra minutes in a patient’s room, but it may make all the difference in that patient’s quality of care and health care experience. It does not matter if your patient is 3 or 83, trust in their medical provider is important to them, and the communication styles needed to earn that trust is can be very diverse between patients across the entire lifespan. Never underestimate the role trust can play in medicine… or the lessons you can learn from a 3-year-old on a pontoon boat.

Acknowledgements: I want to thank my nephew Jasper for bringing me this amazing lesson and helping me further realize the diversity of communication styles that exist between patients and across the lifespan. I also want to thank the patients that I work with every day who are consistently my greatest educators in the art of communication.

Author Bio: Domenic is currently a 3rd year Doctor of Physical Therapy School student in the Mayo Clinic School of Health Sciences. Right now he is working at Saint Marys Hospital out of the 1-Domitilla physical therapy office seeing a mixture of general medical, orthopedic/trauma, and cardiac/vascular patients over the course of a 12-week clinical education experience. From here, Domenic will go to Fargo, ND to work in a Sanford Hospital in an Outpatient Neurology setting.

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