Building Trust is a Matter of Life and Death

By Jame Abraham, MD

Imagine you are sitting in an airplane more than 30,000 feet above the ground. You are watching the mountains and the valley below. You hear the roaring of the engine, and you feel the turbulence. You hear the captain asking you to put on your seat belt.

You know that what is separating you and the mountain 30,000 feet below is a thin layer of metal and machinery, but you really don’t worry about it. You go back and watch your movie or close your eyes and listen to your favorite music.

What makes you feel safe? What sets you at ease? What makes you believe that they will carry you through the turbulence and get you to your destination safely? It is one thing: Trust.

Before you got in the plane, you didn’t inspect the engine, you didn’t question the captain or the crew. Because you trusted the airline and the people flying the plane.

Imagine a world, where we can trust each other and feel safe.

As a cancer doctor at one of the best cancer hospitals in the country, I know that you would not trust me to fly you anywhere, but I hope you would trust me to help you heal.

I know first-hand that building trust is a matter of life and death. Much of this I learned from three amazing women I had the honor of treating.

Cindi

When I met Cindi more than 20 years ago, she was 34 years old. She worked full time and was raising two young boys. She didn’t have time for cancer. But when she felt a lump in her breast, she knew that it was not a good sign. Scans and the biopsy showed a stage III aggressive cancer. She was my first patient as a cancer doctor.

I’d just finished my training from the National Cancer Institute, and had just published a textbook on cancer treatment. I was very confident that I knew how to treat Cyndi’s breast cancer. But I was wrong.

Cyndi came prepared with a thick notebook filled with questions. She grilled me for hours. I didn’t have all the answers, but I was prepared to find them. She shared her story with me about her hectic work schedule, and her dreams and hopes for her kids.

At the end she started the treatment. She even enrolled in a clinical trial with a new medicine. She did everything I asked her to do.

Today, she is cancer free. She taught me to be a better doctor. She still comes to see me, even after 20 years. She drives six hours one way for our 30 minutes appointment. Of course, we talk about her health, but we talk more about what is happening in our lives.

How did we build trust? I made time for her and listened to her story. As a well-trained cancer doctor, I knew how to treat her cancer. But by listening to her story, I knew how to treat Cyndi.

Maria

Maria was a 54-year-old single mother of four. She worked in housekeeping at various places, including in hospitals. She had insurance, a car and a cat named Kitty.

One day, Maria felt a lump in her breast, and it continued to grow until it started to bleed. She knew it was cancer. She was living only a few miles from large hospitals where she could easily access the care she needed. When the lump appeared, she tried to see a doctor, but the experience was not pleasant — so she never went back. Maria didn’t find someone who was willing to listen to her.

This is not an outlier experience. In fact, studies show that doctors interrupt patients every 16 seconds.

She didn’t have the courage to walk into another doctor’s office until her cat, Kitty, was unable to sleep on her chest due to the growing tumor in her breast. That’s when she decided to try another doctor and came to see me.

When I saw her, we talked about her beloved cat and her sons. When she talked about her son in the Navy, her eyes lit up and she became animated. She talked about her mother, who she was taking care of until she died of dementia.

But by the time I saw Maria, the cancer had spread to her liver. It was too late.

What delayed her diagnosis – and eventual death from cancer – was lack of trust. As a health system, we failed to earn Maria’s trust.

That’s what I mean when I say, building trust is a matter of life and death.

Sylvia

Sylvia has been my patient for about 15 years. She had stage III breast cancer. After completing her standard cancer treatment, she enrolled in a clinical trial for a year, as per my recommendations.

Recently she came to see me, and she is doing very well, with no cancer. After giving me a hug goodbye after our visit, she hesitated. “Doc, can I ask you question? Do you think I should take the COVID vaccine?”

I was shocked. This was almost two years into the COVID pandemic and more than a year after billions of doses of the vaccine had been administered.

I said, “Sylvia, 15 years ago, when I walked into your room and recommended a breast cancer clinical trial with a new drug, which was hardly taken by 1,000 patients around the world, you didn’t hesitate. You just took the medicine. Now this vaccine, which is has been tested in nearly half a million patients and found to be effective, taken by billions of people around the world, why are you hesitating?”

Sylvia said, “I just don’t trust them.”

More than 300,000 people died in the U.S since 2020 because they didn’t trust the vaccines or didn’t believe that COVID-19 was real. We have now reached a grim milestone of one million patients dying from COVID. That is the highest number among the wealthy nations.

It is easy to build hospitals and vaccines, but it is not easy to build trust.

In my experience as a cancer doctor for more than 20 years, I believe the cornerstone of any relationship or successful doctor-patient relationship is trust. Don’t treat a patient like a broken machine. It is important to cure, but it’s more important to heal the person.

The three building blocks of trust are:

• Listen to stories. They connect us at a human level
• Be honest. None of us is perfect. Accept our weaknesses
• Show care. Kindness and empathy earn credibility.

The world runs on trust, and it is certainly the oxygen of our healthcare system. While patients are the most dependent on this trust factor, doctors have the greatest duty to earn their trust.

Jame Abraham, M.D., FACP, is the chairman of the Department of Hematology & Medical Oncology at Cleveland Clinic and professor of medicine at Cleveland Clinic Lerner College of Medicine.