While we appreciate the importance of trust, not all patients have the same windows of opportunity to establish it with their physicians. The nature of each specialty and the severity of the patient’s condition influence how quickly and deeply trust can be created and maintained. The STEMI patient will quickly learn to trust the interventional cardiologist, and the trauma victim, and the surgeon.

Not surprisingly, it’s very challenging for physicians who practice a specialty in which long-term, trusting relationships are not the norm (e.g., anesthesiology, emergency Medicine) to create deep trust with a patient.

Why should they trust me, an emergency physician? Most of my patients know nothing about me before their visit. They’ll likely never know me well (except for a few “familiar faces” I see recurrently). And many ED patients don’t have the kind of life-threatening emergency that forces the quick establishment of trust, such as in a STEMI or major trauma.

Meanwhile, my mother looks to me solely because of our long-standing relationship for neurosurgical advice, despite my lack of significant training or knowledge of this field.

I was deeply touched by the story of a friend who attended the ED of a different hospital in our health system. He repeatedly mentioned his gratitude for how the physician made him feel very comfortable, not only physically but also socially/relationally, despite the brief relationship; the physician quickly built confidence and trust.

How can we quickly develop that kind of deep confidence and trust? The kind my father had in his cardiologist. The kind my friend had in his ED physician.

What would I want or need to quickly trust an ED physician?

I would want to know the following:

• Something about my physician (a way to relate to them: where they were born/grew up/went to school/live; what sports teams they like; their non-medical interests)
• A way to get updates on my condition
• A way to inform them about changes in my condition
• A way to get lab, imaging, and consult results; and
• A way to get in touch with them after discharge, in case there are complications to my treatment plan.

“Wait!” you think. “Patients don’t contact their ED doctor after discharge.” (Some consider that one of the specialty’s benefits.) Or, you may worry, “Patients will contact me incessantly and unnecessarily.”

I thought so, too, but took a leap of faith.

I created a form to allow patients to know a bit about me quickly, the “plan of care” (what I’m thinking about their case and planning to do diagnostically and therapeutically), and how and when to reach me after discharge if needed.

I’ve probably given this form to 500 or so patients. I confess to being a bit selective regarding the patients I give the form to. (There’s no need to be hounded by people seeking chronic pain medication refills). But I’m not extraordinarily selective.

Patients very much appreciate the form. So do I. It is often helpful to me on the same shift that I’m seeing the patient: patients will call me during the shift to inform me a consulting service I called saw them (something I wouldn’t know, now that many services don’t notify us they’ve seen the patient, let alone discuss their thoughts or teach me what to consider in future similar cases). And I’ve found the form a helpful adjunct in making nervous or skeptical patients feel safe for discharge. With my schedule and phone number, they have a safety net, even if they rarely use it. The psychology of a safety net builds trust.

My fears of being “abused” by patients were wildly unfounded. Of the 500 or so patients I’ve given the form, I’ve received after-discharge calls from perhaps four; all were legitimate. For example, “The pharmacy you sent the medications to is closed. Can you send it elsewhere?” “The orthopedist no longer takes my insurance. Can you refer me to someone else?” Because we spend nearly all our waking time thinking of medicine, we fear patients do so also and will try to discuss their cases with us at all hours. My “trust-building” experiment has proven this is categorically not the case: Patients want to go through their lives doing almost everything other than thinking about their health and talking with doctors. They respect our time and privacy.

If you don’t believe me, try it with one patient. It’s a low-risk proposition with great rewards. And better suited to a physician-patient partnership than other popularly-touted trust-building exercises that would be less appropriate in the ED, such as a “trust fall” or “blind taste test!”

You and your patients will be grateful for the trusting relationship, even if it’s only short-lived.

The author is an anonymous physician.