In the field of medicine, trust and rapport are crucial. There is no way you could get a patient to open up anything about themselves, or to even get an accurate history if you aren’t able to establish some level of trust from the patient.

For some patients, this trust comes about easily. For some others, not so easily. It all depends on the patient, and how well the doctor conducts themselves.

Telling patients my name and role gives a great start to establishing trust. Making good eye contact, and a warm smile gives patients the impression I’m approachable, and willing to listen. From then on, starting with something like “what brings you in today?” helps to break some of the ice in the initial encounter. Patients will spend a bit of time on their presenting complaint, and with their talking, they start to establish some more trust.

In general, I have found this to work very well with the majority of patients. The ones this havn’t worked so well on have been some psychiatric patients (more likely the ones who have psychoses) and some patients who seem to hate doctors in general.

What’s surprising to me however, has been how easily at times people place trust in me. I mean, in taking a gynaecological history, I ask females if they have a regular sexual partner. One woman brazenly offered that she and her partner have not been having sex lately (with partner right beside her), and another woman who had menorrhagia offered that she had been refusing to have sex with her husband due to the menorrhagia.

I think that this level of trust can be established, because there is the expectation that the doctor shall treat all information about their patients as completely confidential. We are not even allowed to divulge information about a patient’s diagnosis or medical consult to their partner until we obtain permission from the patient directly. The only time we are allowed to break this confidentiality, is in the case of protecting the patient’s health and well being and that of other people (eg contacting driver licensing authorities in cases of epileptics who continue to drive).

It is expected also, that in getting such information, such confidential information can be passed on to others directly involved in the care of the patient. So, such information may be relayed to senior doctors, nurses, physiotherapy and so on. But it would be a breach of confidentiality to pass on all the identifying information and history to someone like a colleague who isn’t at all involved in the care of the patient.

But at the end of the day, doctors are trying to provide the best care to the patient, and sometimes such private information is required to help provide such care. And I still find it remarkable with how much private information some of the patient’s offer on questioning, something they may not have even told their mothers or close friends. It still amazes me how much trust complete strangers I’ve only met for a couple of minutes place on me.