3 Provider Communication Strategies for Creating Patient Trust

Using language judiciously

Driving trust in patient-provider relationship hinges on strong communication, but especially among more vulnerable populations, language barriers can get in the way of that.

A 2018 study published in the Journal of Medical Internet Research revealed that cultural and language barriers can keep patients and providers from creating a trusting relationship.

The study, which included qualitative interviews with English- Spanish- and Mien-speaking patients at a community health center (CHC), showed that those who did not speak English had a difficult time building relationships with providers and administrative staff.

“For the Spanish-speaking and Mien-speaking patients, speaking a language other than English added another layer of complexity and difficulty regarding basic interaction with doctors and staff, as well as interaction with residents specifically,” the team reported.

Of course, it is unreasonable to ask that all providers be proficient in all of the languages spoken in their clinic’s region. But there are some strategies they can lean on to create a clearer and more productive conversation with patients who do not speak English.

Study participants who spoke Spanish or Mien stated that working through an interpreter helped establish a more trusting relationship between them and their provider. Interpreter services were enhanced when the provider emphasized tone of voice, used visual cues, and attempted to communicate even a little bit in the patient’s native language.

Creating a non-judgmental environment

Language issues do not always start and end with an interpreter service, research shows. Even when both patient and provider speak English, researchers say providers need to be mindful of using non-judgmental language with patients.

Research shows that clinician bias in the form of “medical fat shaming” can get in the way of patient care access and patient trust.

Medical fat shaming can happen when a provider uses harsh words or strong comments as a means to drive patient motivation to lose weight. The belief is that the patient will adopt healthier lifestyle habits if their provider firmly points out that they are overweight or obese.

But this strategy often does not work, the research out of Connecticut College revealed. Patients on the receiving end of this strategy can become mistrustful of that provider and may choose not to access care from them.

Even smaller comments or actions, which the researchers called microaggressions, can be perceived poorly by patients and impact their trust levels.

It is important that providers adopt less judgmental language and lean on their empathy skills in these situations. Using motivational interviewing and open-ended questions will help providers determine what will actually push their patients toward behavior change, ideally achieving that set clinical improvement goal.

Creating a non-judgmental environment will also be important in a setting that treats primarily vulnerable patient populations. Providers practicing in community health clinics and other safety-net clinics must be mindful of the everyday challenges that vulnerable patients – primarily low-income and potentially homeless patients – may face that may make them feel shame.

For Anita Ravi, MD, a family medicine doctor at the New York City-based PurpLE Clinic, this meant adjusting some of the language that providers sometimes take for granted.

For example, during patient interactions, Ravi noticed patients apologizing for not wearing underwear or other situations patients perceived as embarrassing, she explained in a previous interview. But Ravi didn’t think those patients needed to be embarrassed – maybe they only had one pair of underwear that needed to be cleaned. Maybe it was bothersome, or the patient didn’t have access to undergarments.

“Now I change the language in how I talk about it with people,” Ravi said. “I say, ‘Okay, and if you just want to undress from the waist down, and you can put everything on the side.’ I don't want to imply societal pressures anymore. I'm trying to be as respectful or sensitive as possible, and you just have to learn and do better each time.”

Leveling with the patient

Trusting patient-provider relationships will also hinge on honesty, experts say. Providers cannot build patient trust when they do not disclose important medical information or are opaque about the consequences of certain therapies or outcomes. Telling the truth about a shaky prognosis or dicey odds of recovery will help patients and their families make better healthcare decisions.

But this level of honesty goes beyond clinical discussions. Providers need to establish a strong sense of trust with their patients during social determinants of health (SDOH) screenings.

SDOH screenings are new territory in a lot of clinics, and patients may not be used to their providers probing them about factors that seemingly have nothing to do with a clinical diagnosis.

That burden is felt acutely in the pediatric setting, where SDOH conversations between parents and providers elicit significant fears. Parents may be unwilling to disclose certain social circumstances for fear that they will be reported to child protective services, according to a new report from Public Agenda and United Hospital Fund.

Patients also fear that providers will use information in an SDOH screening against them, will be judgmental about social issues, or will not have resources to help the patient.

Providers need to be honest with patients to assuage those fears. Foremost, that means providers need to discuss with parents what types of information could spark a call to social services. Additionally, providers should discuss how they use SDOH data and how these screenings are becoming a part of standard primary care protocol.

Getting patients to trust their providers enough to chat about housing or food insecurity will be essential to uncovering potential limitations and referring patients to key social supports.

Ultimately, good medicine will rely on patient trust. Patients who trust their doctors are willing to disclose enough information to help providers make good treatment decisions or referrals to key community benefits. In turn, those trusting patients will feel good about heeding provider advice.

By remaining empathic during provider interactions and providing support for the patient, clinicians can work toward a patient-provider relationship marked by trust.