6 ways to quickly build patient trust

Without the luxury of architecturally designated walk-in medical facilities, pre-scheduled appointments made through trust-building conversation or written communication, thoughtfully decorated offices, glossy preparatory brochures and all of the things that go along with non-EMS related patient interactions, we have to hit the ground running and hope to connect effectively with patients – right from the get-go.

The very fact that patients are facing an emergency situation and are forced to call 911 automatically suggests that they will likely be on high alert, hyper-aware of everything we say and do. So, the pressure is on from the moment we arrive on scene. Quickly gaining trust becomes our immediate focus.

|More: One for the Road: Patient rapport

Regardless of intellectually delivered words and impressive, skilled actions, it’s the small subtleties, like body language and facial expression that make all the difference. A common psychological formula ranks communication elements’ importance as being about 55% body language, 38% tone of voice and only 7% choice of words spoken [1,2].

If we cast our minds back to any personal experiences that involved feeling way out of our depth, it is easier to relate to just how closely we will look for clues, perhaps during medical procedures, skills assessments, stressful interactions with people we care about or altercations witnessed. Honing in on what we see, with our own eyes, often helps to know whether to trust what we’re being told or the interventions and decisions underway [3].

The type of trust we’re aiming for is that which makes patients feel confident in the level of care we will provide and, as a result, become willing to engage, despite any vulnerabilities arising from their situation [1]. So which points should we focus on in order to quickly gain trust in patients and their loved ones?

1. Body posture shows our level of interest in the situation, encouraging or discouraging a sense of safety, and therefore flow of speech and potential information gathering. Active listening clues show patients that their words are being heard. If we’re standing half-in and half-out of a doorway, behaving in a distracted way, or trying to multi-task when not strictly necessary, no matter how convincing our words are, it will be immediately obvious that we’re not actively seeking to understand the information they are providing [1]. Similarly, stance and proximity to the patient go a long way towards appearing trustworthy, non-threatening and actively interested [2,3].
2. Facial expression corresponds to countless emotions, but there are six which are considered definitive; when we’re happy, sad, surprised, angry, fearful or disgusted [1]. Although not always accurate in judging trustworthiness, facial expressions are immediately recognizable, and therefore can quickly affect perception [4]. Often, in the first responder environment, we wear sunglasses, making it even harder to convey expression, particularly in establishing initial eye contact and demonstrating interest during conversation [2,3]. The benefit of seeking insight through a person’s gaze may be presumed knowledge, but research demonstrates that even pupil size plays a large part; therefore even a brief moment of lifting the lenses, just to make that connection, can prove invaluable [5].
3. Touch is considered universal in caring, both during interventions and in conveying messages of emotion or understanding. Any hands-on connection, therefore, is more than likely going to indicate our level of care, and whether it supports or contradicts what we’re actually saying [1,2].
4. Mimicking gestures and feelings can cross many divides and doesn’t have to be as formal as sign language. Simply nodding in agreement along with the patient or copying relaxed hand gestures can be useful in demonstrating that we’re on the same page, or at least the same wavelength. Also, noticing a patient’s gestures and acknowledging them, just as we do with spoken word, can help to build the quality of communication each patient needs in order to trust fully [1,3].
5. Attempting to connect with trusted caregivers in circumstances where confusion, impaired cognition or extremes of age form a barrier will help some patients to feel safe. Children, in particular, are more likely to look to someone they already know and can trust so that they can make a decision based on third-party opinion [6].
6. Authenticity is vital in backing up each of the tools described here. Despite everything we say or do on a call, if we fall into robotic mode, our actions will be out of sync and we’re likely to lose trust rapidly as a result [1]. Non-verbal communication can be a double-edged sword. It either supports our words and actions or, more dangerously, belies our true feelings in the moment, contradicting everything that we’re attempting to convey [3].
7. Gaining trust and maintaining it can be challenging, particularly within the miniscule timeframe we face when arriving on any call. On those occasions when it’s difficult, or if we lose our footing along the way, throwing in a genuine, warm and reassuring smile may help in connecting; especially if we can take moment to pause, regain eye contact and give the recipient a chance to catch up, too [2,6].

There’s a whole lot more to EMS than vehicles, uniforms, credentials and training. Genuine efforts to connect on some level will usually help to build and maintain trust on each call, enhancing our profession’s reputation along the way. After all, we are humans, signing up to care for other humans, so what better way than some good, old-fashioned human interaction to make everyone’s lives easier?

|More: 4 things to explain to patients to increase their comfort and compliance

References

1. Benbenishty, J. S. & Hannink, J. R. (2015). Non-verbal communication to restore patient-provider trust. Intensive Care Medicine, 41, 1359-1360. DOI https://doi.org/10.1007/s00134-015-3710-8
2. Dalonges, D. A. & Fried, J. L. (2016). Creating immediacy using verbal and nonverbal methods. The Journal of Dental Hygiene, 90(4), 221-225. Retrieved from https://jdh.adha.org/content/jdenthyg/90/4/221.full.pdf
3. Phutela, D. (2015). The importance of non-verbal communication. The IUP Journal of Soft Skills, IX(4), 43-49. Retrieved from http://library.tuit.uz/knigiPDF/Ebsco/8-1106.pdf
4. Lucas, G., Stratou, G., Lieblich, S. & Gratch, J. (2016). Trust me: multimodal signals of trustworthiness. Proceedings of the 18^th ACM International Conference on Multimodal Interaction, 5-12. DOI https://doi.org/10.1145/2993148.2993178
5. Kret, M. E. & De Dreu, C. K. (2019). The power of pupil size in establishing trust and reciprocity. Journal of Experimental Psychology: General, 148(8), 1299-1311. DOI https://doi.org/10.1007/s00134-015-3710-8
6. Tang, Y., Harris, P. L., Zou, H. & Xu, Q. (2018). The impact of emotional expressions on children’s trust judgments. Cognition and Emotion, 33(2), 318-331. DOI https://doi.org/10.1080/02699931.2018.1449735

This article, originally published in October 2020, has been updated.