What difference does trust make to doctor wellbeing?
“There is a difference between a group of people who work together and a group of people who trust each other”.
– Simon Sinek
Working together can largely be transactional, possibly polite and friendly, guarded and not necessarily requiring emotional connection. Many of us can work together without ever sharing much of ourselves. Health care workers are masters at this, taking care of patients without getting personal, without sharing. Hold the patient at arm’s length has been the standard education for doctors in recent decades and most of them are extremely competent at their work.
This has often been the case between healthcare colleagues too, competently transact work together in a team, but not actually looking after each other at work. The culture of our healthcare system has a strong thread of; make sure you look like you are ok and never tell me if you are not, I’ve got my own problems, running through it. We have plenty of expressions for this, here’s a sample:
- If you can’t stand the heat get out of the kitchen
- Keep a stiff upper lip or a smile on your face
- That’s nothing, wait till I tell you what happened on my shift
- Get used to it, this stuff happens every day
- In my day we worked 30 hours straight and it never did us any harm
For doctors, there are plenty of career imperatives that keep people from sharing how they really feel, not least, fear of being reported to AHPRA* and not advancing onto a training program or gaining the experience required for the next step in development. Medical training is closely tied to who you have trained with, whether they will recommend you and whether you have had the right opportunities – which often depends on the aforementioned.
None of this breeds trust or encourages vulnerability. In fact, the systems and processes that currently exist for development of junior doctors, breed the wrong kind of vulnerability, one that creates fear, shame and secrecy. For a junior doctor to advance their skills through experience and then to achieve a place on a training program they need to follow the rules, look like they can cope with extraordinarily high levels of stress with little support and be technically competent. There are simply not enough training places for all of them and effective people skills which are defined narrowly by medicine, don’t necessarily get a mention unless you are seen as a troublemaker. So keep your head down and focus on technical skills is seen as the best way for many junior doctors.
On the other hand, people who trust each other feel safe and are willing to share, to be vulnerable. Brene` Brown defines vulnerable as “the emotion that we experience during times of uncertainty, risk and emotional exposure”. She expands this saying “it’s having the courage to show up when you can’t control the outcome”. To feel fear or love and to express either of them, is to be vulnerable. To ask for help, to say I don’t know, to cry at a disappointing outcome for a patient, to admit that you are tired or preoccupied or scared. These things all take courage, it is in psychologically safe environments that we find our courage. We cannot trust without vulnerability, taking small risks and learning that we are still safe is how we build trust in others and in ourselves. Doctors feel vulnerable by the very nature of their work, there is much at stake, where they work in a psychologically safe team, where there is trust, they can do their best work.
To build high performing teams trust comes before performance. The patient wants to be in a high performing team with their doctor and other providers. The patient knows that they will get better, best inside this kind of team.
When a patient trusts their doctor (their healthcare partner) they tell them what’s really worrying them, what’s most important. They tell them about the supplements they are taking or the naturopath they consulted. The doctor gets a fuller picture and the healthcare outcomes are better. In addition the work is more satisfying for the doctor.
The transactional doctor is technically competent and the patient expects him/her to be, that’s why they made the appointment in the first place. The doctor, given his/her registration and training is assumed to be able to do their job from a technical sense, it’s not questioned.
Trust however, goes to character. Trust is the ingredient that allows for psychological safety. Trust means that when there is bad news to deliver the patient and the doctor feel safe to talk it through and make a plan, the patient feels cared for and the doctor can keep doing his/her job without burning out. High trust people want to grow and want to help others grow, both parties need to engage in many small risks over time for trust to develop, because as humans we are hard wired for the negativity bias, we are wired to protect ourselves. We only trust, take risks, let our guard down when we feel safe and confident in the others around us. Working in a high trust teams allows us to extend ourselves knowing that others will help us if there is a problem without blame and shame.
In healthcare, like in all other fields of human endeavour we get the behaviour we reward. In healthcare we have rewarded throughput, speed, diagnostic efficiency and quick assessment. We have practiced a bias toward resources, rather than will. We have biased performance before trust. We have not consciously turned toward human connection, will and trust, to understand and heal. The cultural norm of medicine is hurried, restricted to that which is easier to measure, siloed and finite. The research shows us that we have lost our way in terms of empathy, compassion and burnout, and perhaps all health practitioners have experienced this disappointing reality one way or another. In rural regions it is especially stark where need dramatically outstrips the number of health professionals. This is especially evident in mental health.
Humans have a deep need to belong, to be seen and heard, to be recognised. When this happens, we feel safe. When we feel safe, we can be accountable, engaged, participate and be resilient. These are the qualities of a healthy organism, in this environment people get better and health care providers have sustainable careers because they are supported and well too. When human connection, trust and will are valued as the essential environmental qualities to deliver health care, we will see high performing teams who are more effective with our resources. Patients and providers will do better and be better.
* though AHPRA are working hard to change this perception including changing the laws around mandatory reporting.
References:
- Brown, B. Dare to Lead, 2018, Penguin Random House, UK
- Sinek, S. The Infinite Game, 2019, Penguin Random House, UK
Sharee Johnson is the Founder of Coaching for Doctors, she works as an executive coach, psychologist and meditation teacher. She is committed to helping doctors change the culture of medicine to care for everyone properly, including doctors.