The Trust Practitioners: the health of service excellence

The Trust Practitioners: the health of service excellence

It is pretty difficult not to think of one’s health in the times we find ourselves in. All thanks to a certain virus. For close to two years, we have been harangued by this deadly pestilence and it does not seem to be going away any time soon. A virus with different variants and mutations obviously means business.

We have to live with the clear and present danger of finding ourselves in a situation that would require having to visit a health facility. The visit could be either as a patient or as a visitor—and nobody really looks forward to either of these situations. In our part of the world, one can only hope for the best of experiences, if such a visit ever became necessary.

Service excellence and healthcare have never been known to be close bedfellows. The regular scary encounters one hears, as well as the occasional horror stories of poor patient treatment that appears in the media, further fuels the notion that healthcare and service excellence do not normally go hand in hand. As a patient, the best you could hope for is to be treated well enough and in time enough for you to get out of the encounter as quickly as possible.

The ease with which a senior colleague in the consulting business recently dismissed the services of one of the best hospitals in the country is simply worrying. A few weeks ago, he was taken to that facility with a suspected COVID-19 infection. That particular hospital was chosen because, from the outside, it seemed like the best place.

Evidently, I was not with this senior colleague inside the hospital but the way he narrates the ordeal he went through sends shivers down my spine. Unfortunately, his is far from an isolated case. Many are those who have gone to that hospital—and many other health facilities in this country—and come out with horror stories of inconsiderate nurses, arrogant doctors and all-round unprofessional behaviour of staff. Unfortunately, many patients never even make it out to tell their stories.

It is true that negative stories give an indication of how bad a situation is. However, I have also come to realise that the way we handle positive stories can also be a good barometer of how bad a situation really is. The way and manner in which stories of service excellence by medical practitioners are even trumpeted around is an indication that such experiences are few and far between.

This I have experienced at a very personal level. Sometime in December of last year, I had the scariest encounter of having to send my wife to the Greater Accra Regional Hospital—Ridge Hospital, as it is more commonly known. What was supposed to have been a routine check-up ended up becoming a close shave with the Grim Reaper. Had it not been for the timely intervention of two amazing doctors—my old school mate, Dr. Apea Kubi and Dr. Ralph Armah, the Clinical Director of the Hospital, our story might have ended differently. Supported by an equally-fantastic team, these folks saved my wife’s life.

The joy and relief I see in the face of my wife whenever she talks about her experience is enough to tell me that it was not the kind of treatment she expected. She feared the worse. But the experience was far from that. That is sad, if you ask me. The good that should have been the norm is now the exception and the bad that should have been the exception is now the norm.

Growing up as a son of a nurse, I hanged around clinics and hospitals quite a bit. My experience with the medical fraternity then, and even now, tells me that every experience—every single encounter—patients have with a medical facility is predicated on one word—Trust. Trust is the bedrock on which every patient-clinician relationship rests. Trust has been defined as “willingness to rely on an exchange partner with whom one has confidence”

For starters, the trust that a patient has in the competence of a doctor, or a particular facility, has a very important effect on the experience of that patient. If there is no trust, it does not matter how well the doctor performs, the patient will still have issues with the experience. If the patient has trust in the doctor, that trust can even cloud the judgment of the patient. Mistakes by that trusted doctor will easily be explained away by the patient.

Fortunately, and unfortunately, trust is something that must be earned. Fortunately, because that means no quack can just do anything and get away with it. The doctor who is worth his salt must do certain things to earn the trust of that patient. Unfortunately, because earning trust takes some time. Earning someone’s trust is something that cannot be obtained instantaneously.  This is where the doctor’s job gets a lot interesting. On one hand, the clinician has to earn the trust of the patient for the treatment to go well. On the other hand, the trust takes time to obtain. But unfortunately, the physician does not usually have all the time in the world to earn that trust.

If all health challenges are of the chronic type that will require the patient and clinician meeting several times over an extended period of time, things would be a bit different. However, the nature of many health challenges means that there is not enough time for the doctor to earn the patient’s trust. Sometimes, the nature of the ailment means that the doctor-patient relationship has to kick-start as soon as the two encounter each other. There is no time to waste in sizing each other up. In many instances, the patient might not even be in the right frame of mind to make a decision about that particular medical practitioner or not. It is at this point that the difference between the Dr. Ralph Armahs of our time and the others becomes clear.

I was in the consulting room with my wife that late Wednesday afternoon in December. So I saw, at first-hand, the skilful way Dr. Armah earned our trust within the first few minutes of our encounter. Although it was a touch and go situation, one of the first things I noticed was his calmness. His calm demeanour was enough to get us to relax. Something about the way he handled the situation told me that the situation was quite serious. But the doctor was relaxed so we naturally followed suit.

But of all the things the good doctor did that day, I believe, the most important was the giving of information about my wife’s condition. The way he even went about this was as reassuring as it could be. Rather than “preach down” on us, he asked me to pick out my phone and to Google the condition. He then asked me to read out aloud what I found. So at that moment, this wonderful doctor treated me, the husband, like an “understudy”. This doctor made sure we participated in the process and this earned him a lot of trust with us.

Today’s patient can acquire much more information and knowledge about whatever ailment she is dealing with than the patient of yesteryears. A simple Google search of “How to treat a headache” is sure to churn out more than 218,000,000 results. “How to cure a cold” will bring up more than 330,000,000 results. That is simply staggering.

With such a preponderance of information at her disposal, today’s patient will want to participate in the healing process. It is advised that health workers do not play down the self-knowledge of patients but rather to consider what patients know about themselves and what is ailing them alongside the medical expertise of the clinician. However, in bringing the patient to participate in her own healing however, the doctor must be skilled enough to handle the potential of patients disagreeing with a certain prognosis or even diagnosis. A patient who has read something on WebMD OR Medscape might have issues with a decision by the doctor. The doctor is not expected to leave the patient to her own devices but to skilfully bring that patient around to seeing things the physician’s way.

This is where the world is at the moment. Information that was the exclusive reserve of the medical practice is now splashed all over the Internet. The days of passivity when dealing with health workers is fast fading, if not long gone.

It is one thing to have information and it is another thing to know how to communicate. The role of communication in building trust is something that is widely known. Communication serves as the vehicle for building trust in any relationships, including the relationship between doctors and their patients. A February 2014 research report published in Materia Socio Medica, the journal of the Academy of Medical Sciences in Bosnia and Herzegovina intimated that there was a strong link between good communication between nurses and patients and the “successful outcome of individualized nursing care of each patient.” According to the study, courtesy, kindness and sincerity were key if the nurse is to win the trust of patients.


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