Building trust: the importance of first impressions in medicine

The initial consultation with a doctor or a medical specialist can significantly shape a patient’s experience and their trust in the health system as a whole.

We spoke with Dr Anthony Brown, CEO of Health Consumers NSW, and Dr Danielle Delaney, a Medical Council hearing member and experienced urologist, to explore how specialists can make the most of that first consultation and build trust.  

The importance of communication

Both Dr Delaney and Dr Brown believe that effective two-way communication with a patient, especially at a first consultation cannot be overstated.

Dr Brown emphasises that effective communication is not merely a supplementary skill but a fundamental aspect of quality healthcare. “Communication is a safety and quality issue. It’s not a nice-to-have, it’s at the heart of healthcare,” Dr Brown states. 

He further emphasises the importance of communication when delivering quality healthcare. “If we want safe, quality healthcare, then that can’t happen without good communication.” He highlights that poor communication can be as harmful as inadequate clinical care, eroding trust and leading to formal complaints if patients feel their concerns are not addressed. 

Dr Brown provides an illustrative example, “One example I can think of is a person who is nonbinary, and the health practitioner was very good but kept misgendering the person despite being corrected. The patient felt they were not being respected and it was an important part of who they are. They had no complaints about the clinical care, but there was this mismatch between their treatment and the communications, so they lost confidence in the doctor.”  

Dr Delaney adds, “Effective communication is vital. As a physician, I gain invaluable insights by actively listening to my patients and allowing them to share their experiences. The initial consultation is crucial for establishing trust and rapport; even the most skilled specialist can be disregarded if the patient lacks confidence in their care.” 

Building rapport in consultations

An initial appointment with a patient isn’t just about clinical assessment but also about establishing trust and rapport with the patient. Dr Delaney notes, “As a specialist, we can frequently infer the diagnosis from the referral letter and formulate a management plan prior to the patient's visit. However, it is essential to effectively communicate and ensure the patient partakes in shared decision making during the initial consultation.”

Dr Delaney stresses the importance of using plain language and simplifying complex medical information. “Most patients come from a very different education background. You need to take time and use plain language, be direct, clear and simplify. Explaining scans and pathology results as well as using diagrams,” she explains. Allowing patients to share their stories is also an important aspect of building rapport. “I believe it’s crucial to allow patients ample time in the initial consultation to share their story, as this narrative is their lived experience. When they feel heard, their trust in you grows,” she adds. 

Managing appointment times effectively is another key aspect as short appointment times and delays can lead to patient frustration. Dr Delaney notes, “Most of my initial consultations would be 30 minutes so there’s time to build trust and talk through everything. Patients don’t mind if it’s a short consultation if you’re on time, but they get upset if they’ve waited a long time and you cut them short.”

Navigating communication challenges

Dr Delaney identifies several challenges in communicating with patients. “The things I find really challenging are the patients who come in and the diagnosis might be uncertain, there might not be a specific diagnosis, or the patient comes with fixed expectations.” She advises being transparent about uncertain diagnoses and the steps you are taking to find answers. 

Shared decision-making is also crucial. “Most of the time I say, ‘this is where we’re at, these are our options, including doing nothing.’ The only time I’m definitive is when I know it won’t get better unless we do X,” she explains. This approach ensures that patients are fully informed and involved in their care decisions. 

Importance of communicating with GPs

Dr Delaney also highlights the importance of feedback and communication with referring GPs. She suggests that timely and concise communication back to GPs is beneficial. “Referring doctors appreciate clear, succinct updates that include diagnosis and management plans.” she notes. This communication back to the GP means that any treatment plan is clearly mapped out and patient care remains at the forefront.  

Informed consent

When it comes to informed consent, Dr Delaney advises clarity, “I say, we can sign the consent form now, but you can change your mind right up until we go into the operating theatre.” Providing patients with the freedom to reconsider helps them make decisions with complete information. 

Dr Brown points out that good communication is essential for informed consent. “There are two fundamentals of good medicine. The first is do no harm, and bad communication is harmful. The second is informed consent, and patients can’t be informed if they don’t understand,” he explains.

The focus for doctors should be on ensuring patients understand their options and the implications of their decisions, including risks associated with those decisions, not just on obtaining a signature. 

Enhancing the consultation experience 

Both Dr Brown and Dr Delaney believe creating a welcoming environment is invaluable. Dr Delaney prefers to sit side-by-side with patients rather than across a desk, or wherever is appropriate for the patient. “I see a lot of kids, so sometimes I’ll be sitting on the floor playing with them during the consultation,” she says. These small adjustments can improve patient comfort and engagement. 

Dr Brown notes “We need to partner with patients and health consumers in designing communication tools and resources. Even services that are excellent at communicating with some groups can be slow to adapt their messages and communication strategies for new communities. For example, women living with HIV, and boys and young men experiencing eating disorders often report that they feel ‘out of place’ in existing specialised services where treatment and communication messages haven’t been designed with them in mind.”

The importance of feedback

Feedback mechanisms are essential in medicine, as Dr Brown highlights. He explains, “If a patient has a bad experience and no opportunity to provide feedback, they will likely turn to regulators like the Health Care Complaints Commission (HCCC) or the Medical Council.”

Dr Brown advocates for proactively seeking and acting on patient feedback to prevent complaints and enhance care. He also notes, “Good communication is a key component outlined in the Australian Charter of Healthcare Rights, which all accredited medical practices in Australia are accredited against. The charter explicitly states that people receiving healthcare have the right to good information and to provide feedback.” 

Dr Delaney suggests implementing patient satisfaction surveys to gather feedback and refine the consultation process. “You might not gather feedback during the consultation itself, but your administrative staff could collect it or send a follow-up email. Although many of us may not view ourselves primarily as customer service professionals, we are, in fact, in a critical customer service role.” 

Key takeaways:

• Effective communication is essential in medicine as poor communication can erode trust emphasising the need for you to engage actively with patients.
• Using plain language, allowing patients to share their stories and ensuring they feel heard can help build trust and rapport.
• Gathering feedback from patients can be valuable, as it provides insights into areas where you can improve your consultation and your patients experience.