Crucial to Rheumatic Care: Insights into the Importance of Trust

SAN DIEGO—A trusting relationship between patients and their rheumatology providers is not automatic and requires conscious effort on the part of physicians. After trust is established, the relationship can have real effects on health outcomes, panelists said in a session at ACR Convergence 2023.

The session addressed what is at stake when trust may be lost or never gained, as well as challenges to bolster the attention that is given to the entire panoply of a patient’s symptoms.

Be Trustworthy

Joy Buie, PhD, MSCR, RN, vice president of research at the Lupus Foundation of America, said there were many reasons for patients—particularly in racial and ethnic minoritized communities—to distrust the medical system. Historical examples of situations that created the persistent mistrust of the medical community include the Tuskegee syphilis study in which 600 Black men were not informed of the study’s nature and 400 men with syphilis were not treated despite the availability of a proven treatment and the harvesting of cancer cells from Henrietta Lacks without her knowledge or consent to create a cell line for medical research.^1,2

Dr. Buie suggested that it’s ineffective, and even unethical, to ask a patient whose ancestors may have experienced discriminatory and unethical practices to trust a medical system that has been historically untrustworthy. “Perhaps it’s not on the part of the patient to trust the provider,” Dr. Buie said. “Perhaps it’s on the part of the provider, as well as the healthcare system, to be trustworthy. It is only fair for the patient to look for convincing evidence and use their data to make a decision about whether a system or provider is, indeed, trustworthy.”

Several studies suggest that building trust involves factors that sound basic but can be overlooked in practice, Dr. Buie noted. They include honesty, the quality of a provider’s communication, the confidence they cultivate in their decision-making, respecting confidentiality and performing with a high level of competence.³

“This [approach] will ultimately require a shift in how providers and researchers consider trust, such that patient and community perspectives on trustworthiness of the medical enterprise are much more central,” Dr. Buie said.

Beyond Numbers

Lisa Sammaritano, MD, a rheumatologist at the Hospital for Special Surgery, New York, and professor of clinical medicine at Weill Cornell Medicine, New York, said that physicians need to think about more than numerical disease parameters when caring for patients.