o.d. to o.d.

Establish Trust Before Care

You must instill trust in your patients, so you can gain compliance to your recommendations for care and treatment.

BY WALTER D. WEST, O.D., F.A.A.O. Chief Optometric Editor

We've all recognized the need for patients to trust us, our ability, integrity and, above all, trust that we'll recommend for the patient what is in his best interest from the stand point of eye health and vision correction.

In most instances, we see that trust as something that develops later in our relationship with patients once they've had an opportunity to get to know us and experience the level of care with which we provide through time. But, I believe that our ability to reach our patients and be effective in providing care and gaining compliance may actually be one of the first things we must accomplish.

Patient "Fight or Flight"

I never thought these words would come out of my mouth but, I was thinking about how the brain works, the sequence of events and the order in which we process stimuli. Now, some who know me are surprised that I think, let alone that I think about stuff like this, but follow me on this, and let's see where it goes.

As best I remember when faced with a circumstance or environment (a stimulus), the first part of our brain that goes into action or gets to process this stimuli is the brainstem. You know the brainstem. It's the lower part of the brain that connects to the spinal cord comprised of the pons, the medulla oblongata and the mid-brain. It's the part of the brain that first developed (I promise this won't go on much longer). In the brainstem, the first and a very critical assessment is made: "Am I safe or not safe?" This is where the "Fight or Flight Syndrome" has its origin. The midbrain in a split second makes this assessment and produces the appropriate response. When the midbrain determines that a situation is safe, then the neocortex is allowed to assess the stimuli.

The neocortex, as its name implies, is the newer portion of the cerebral cortex that serves as the center of higher mental functions for humans. Different regions of the neocortex allow vision, hearing, touch, balance, movement, emotional responses and our other cognitive abilities.

The reason I've gone through all this: to show that it's not humanly possible to gain or even expect to gain a patient's trust and have him consider your recommended care or treatment options until you've made him feel safe. In fact, until he feels safe, the cognitive or decision-making part of the brain doesn't even get to participate in evaluating the circumstances, consider the diagnosis or attempt to understand your recommendations, let alone agree to follow our advice.

From safety to trust

When I say patients must feel safe, I don't mean safe from bodily harm but rather a more subtle sense of safety — a sense that you, as the O.D., won't sell them something they don't need, or force them into guessing their best option for care.

Patients must have a sense that the recommendations you make are truly in their best interest rather than merely what a third-party payer covers or is more profitable to your practice.

It's all about you

Remember: If you, your verbal or non-verbal communication, your body language and the environment within which you practice doesn't first make a patient feel safe, secure and cared for, the thing they may be ready to fight about or take flight from are your well-intended professional recommendations. OM