Psychiatric Views on the Daily News - Episode 127

Trust is a Must in Clinical Psychiatry

Medical trust: being optimistic that the caregiver will put your interests first.

PSYCHIATRIC VIEWS ON THE DAILY NEWS

Most physician experts on COVID-19 are expressing concern about the recent wave of increased infections, even if the risks of hospitalization and death are less than before in the pandemic. However, some political leaders and parts of the public seem less concerned with masking and other preventive methods in a desire to get back to a more normal life. Some of this disparity may involve inadequate trust.

An adequate amount of trust has long been recognized as important in medical care, especially trust of the physician and other caregivers by the patient. Medical trust is generally characterized as being optimistic that, being a patient in a vulnerable situation, the caregiver will put your interests first.

Trust in clinical psychiatry has always seemed challenging. There are few lab tests to confirm what is wrong. The stigma leads to denial of the problem. The nature of the problems, especially any loss of reality testing, limits trust.

Recently, I received feedback on how I seemed to establish enough trust with patients. A former caseworker colleague wrote a memoir on how he led a patient peer empowerment movement, and in it described his observations of my interactions with patients. Here are some excerpts, and please forgive the self-referencing, but I think it connects with the trust theme1:

“He would take the time to gently explore ways the patient learned to deal with their symptoms shining an encouraging light on the coping skills thus strengthening the patient’s self-confidence. . . When it came time to talk about medication, he would ask them how their medication was working. If there was a complaint, he would ask them what they thought would work best, even if a different medication would work better. . . It usually took them a few sessions for the patient to realize he was serious, and they could trust him. . . I believed this partnership approach also improved his patient’s compliance with taking their medication.”

My colleague said it took some 35 years to recognize this empowering approach, but it took me even longer, until I read his book, to understand what I was trying to do. Perhaps it will help others.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.

Reference

1. Bateman H. Pathway to Treasure: Discovering the Hope Empowerment can Bring Toward Recovery from a Serious Mental Illness. Herb Bateman; 2022.