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Physician weighs in on how patients, doctors can improve their trust

ABC News

(NEW YORK) — One of the most important aspects of medicine is the relationship between a doctor and their patient, according to physician and Yale School of Medicine professor F. Perry Wilson.

However, Wilson said that relationship has been strained in recent years and has led to complications in treating people.

Wilson spoke with ABC News Live Tuesday about his new book, How Medicine Works and When It Doesn’t: Learning Who to Trust to Get and Stay Healthy, and gave tips on how people can improve this relationship.

ABC NEWS LIVE: So it’s January. Everybody has their ideas of getting healthy, and there are a lot of tips and tricks for that. You point actually, though, to the medical system itself is kind of being responsible for some of those gimmicks, if you will.

DR. F. PERRY WILSON: Yeah, well, part of the problem is that people are pushed away from [the] medical system and from good knowledge because a lot of times the health system itself is failing to meet their real needs. We have frustrations with insurance companies, [and] with pharmaceutical companies. You don’t have enough time to see your doctor because your doctor is working for a corporation that is telling you to see more and more patients all the time. And what this frustration leads to is people running away from good science-based, [and] evidence-based medicine and into the arms of people that might not have their best interests at heart promoting unsafe practices. And that can be really bad for your health. We’ve got to sort of change that framework.

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ABC NEWS LIVE: You write, “The most powerful force in medicine is trust.” Explain what you mean by that and where you feel like the breakdown in trust comes from.

WILSON: Yeah, well, that relationship between a patient and their doctor, we call it the Therapeutic Alliance. And I actually like that term because it makes me feel like we’re in kind of a battle against disease. And what that takes is a real deep bond of trust. I have to trust that you’re telling me the truth. You’re being open with me about what’s bothering you and what you’re up to. And you have to trust me that I have your best interests at heart. And when we are trying to work within a framework that is profit-driven, that is insensitive to the real needs of patients, well, that trust doesn’t work anymore.

ABC NEWS LIVE: And when you talk about that trust between the doctor and patient relationship, how does one go about rebuilding that and even establishing it? Because I have to say, when I go into my doctor, I feel like it’s like, I’m just on a clipboard. Okay. How are you doing? What’s your weight? What’s your height? You feeling OK? All right, onto the next person. So how do I actually have that relationship?

WILSON: Yeah, well, so it comes from both sides. For patients, they need to start to realize that a lot of the things they’re seeing online on social media, what I call [an] easy fix or one simple thing, medicine. One dietary supplement to take to give you shredded abs or one exercise to alleviate depression. Those things aren’t real. Real change takes work, and so patients have to move a little bit to understand that, that we’re going to ask some tough things of you; real lifestyle change if you want to get healthy. At the same time, doctors need to start realizing that we’re on the same side as patients. It is us and patients against this system.

And once doctors start to realize that they have more in common with their patients than they do with the C-suite executives who are writing their checks, we can see some real change.

ABC NEWS LIVE: What is good medicine as you define it here in the book?

WILSON: Well, good medicine comes from a number of things. It comes when people look at data and make their conclusions based on data as opposed to deciding what they want their conclusion to be and finding the data that fits. And we live in a world for better or worse. If you want to find data to support what you believe to be true or what you want to be true, it’s out there. It may be false, but you can Google it. It’s on social media. And so people, to make the best choices for their health, can’t just decide what they want to conclude in advance. They have to actually come to it with an open mind and a good doctor. Practicing good medicine is going to help you ask those right questions.

ABC NEWS LIVE: What are those right questions, though? How would I know what I should ask?

WILSON: Well, the most important thing is to be honest about what’s bothering you. And one question that I encourage doctors to ask their patients and the trainees that I work with [is] to ask their patients… “Are you lonely?” There’s an epidemic of despair in the country right now. Death rates among people in the 35 to 55 age bracket who should be really living their best lives are increasing due to alcohol abuse, drug abuse and suicide. A lot of that is due to social isolation, loneliness, [and] despair, and doctors don’t address those issues.

ABC NEWS LIVE: You know, people often say, be your best advocate. You are your best advocate. Right. And so how would you encourage someone? I guess it’s kind of along those same lines as far as just being honest.

WILSON: [There are a] couple of things you can do. No. 1, you can ask this question: What else could it be? This is a question that reframes as a doctor. You’re my 20th patient of the day. I just need to get out, I’m hungry, etc. That question flipped a switch in my mind. That’s going to make me say, “OK, wait, OK, yeah, I think I know what’s going on here, but you just ask, what else could it be?” And it forces me to take a step back and rethink the situation that can be really valuable information.

The other thing you can do is bring someone with you. It’s the same as if you go to a mechanic or anyone else who has sort of expertise beyond what your level is. Having that other person there who’s just kind of a step outside can lead to some better questions, and I’ve had great interactions with patients where I’m talking to the patient and he’s nodding and yep, I get it. I agree. I understand. And his wife will kind of turn and say, “Do you get it? Do you know it? Did you hear what he just said?” And all of a sudden it becomes clear? No, you know, the communication wasn’t there. So, bring an advocate, bring someone with you and make sure your doctor’s OK. Having someone else in the room, they should be. If not, sometimes you’ve got to find a different doctor.

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