HJNO Sep/Oct 2022

CHANGING HOW CARE IS DELIVERED culture of healthcare labels the patient as non- compliant if they fail to follow or adhere to our advice, as if we should just expect, demand, or command that our advice is sacrosanct. It isn’t. It requires trust, and trust needs to be earned. Again, according to Frei, people tend to trust you when they think they are interact- ing with the real you (authenticity), when they have faith in your judgment and competence (logic), and when they believe that you care about them (empathy). All three — authentic- ity, logic, and empathy — are essential to earn trust, and in moments when trust is broken or fails to get traction, it is usually the same driver that gets wobbly on us. Everyone, including all of us physicians, have a trust wobble. But we also have a driver that is rock solid, our trust anchor. I know plenty of physicians who are incredibly smart, stay current with the latest advances in the medical literature, and have such extreme confidence in their own knowl- edge, that for a patient to doubt their exper- tise, for them is nothing short of heresy. These physicians tend to use the word “noncompli- ant” quite a bit. For these physicians, their anchor is logic, but their wobble is empathy. They simply cannot understand why patients choose to engage in unhealthy behaviors. For them, it defies rational explanation. Empathy is the ability to see things from another per- son’s perspective and to understand how that person is feeling. The action arm of empathy is compassion, and coaching with compas- sion has beaten commanding compliance in every industry in which it has been studied. The empathy component of trust is also es- sential to asking the right questions the right way and knowing the answers to several im- portant questions. Why does a person whose father died of lung cancer continue to smoke cigarettes? (Hint: it is NOT because they don’t know that tobacco is harmful to their health.) And why does that person start smoking again after years of having successfully quit, despite being fully aware of their own family history and tobacco’s attendant harms? Why does a person with obesity, diabetes, and high blood pressure, whose mother ended up on dialysis from diabetic kidney dam- age, continue to indulge their cravings for sweets? And how do you address it without them feeling judged or getting angry? One can only know the answer to these questions when they relive the experiences of that per- son’s life and see the world through their eyes. Trust ultimately cuts both ways. If we expect patients to trust us, then we need to trust that patients are not a collection of noncompliant, nonadherent ignoramuses who enjoy being unhealthy. Instead of providers shirking away from accountability for their patients’ health outcomes by asking such questions as, “Why should I be held accountable for their choices and behaviors,” we should be compassion- ately asking why patients would engage in behaviors that could lead to self-harm. Is it because they don’t know any better (logic)? Or is it because their unique cumulative set of life experiences, in many cases marred by adverse childhood trauma, maladaptive cop- ing mechanisms, socioeconomic barriers, and impairments in mental health have taken them down a path that we ourselves were fortunate enough to be spared (empathy)? Shifting into our role as coach, we should then ask ourselves, “How can we lead them to a healthier place?” How can we empower them to unleash their full potential to become the healthiest version of themselves? How can we meet them where they are and lift their mind, body, and spirit to a better place? And how could we ever do it alone? Or does it take empowerment leadership where we coach a team with diverse talent and unique domain knowledge, like behavioral health specialists, dietitians, pharmacists, therapists, and many others? Do current economic models enable and empower us to deliver this type of care? Or do we need to reinvent new business mod- els that start with the patient and work back- ward to overcome the barriers, obstacles, and challenges that stand in the way of delivering health? How can we make such progress with- out relentlessly measuring, tracking, learning, and improving outcomes? And can we lever- age the right combinations of talent, tech- nology, and teamwork to get there? In other words, how could we ever do it without funda- mentally changing the way we deliver care? n “Trust ultimately cuts both ways. If we expect patients to trust us, then we need to trust that patients are not a collection of noncompliant, nonadherent ignoramuses who enjoy being unhealthy. Instead of providers shirking away from accountability for their patients’ health outcomes by asking such questions as, “Why should I be held accountable for their choices and behaviors,” we should be compassionately asking why patients would engage in behaviors that could lead to self-harm.”