Season 4, Episode 18: Trust and the Patient/Provider Relationship

In the latest Just Us: Before, Birth, and Beyond podcast, we dive into a critical topic: trust in healthcare.

Brandon Romstadt (WNC Health Network) and Dr. Bryan Hodge (MAHEC) talk about how patients and providers work together-especially during public health challenges like the recent measles concern in our region.

It's a meaningful conversation about connection, communication, and community care. 

We would love your feedback on our podcast!  Please take our listener survey to provide your comments.

Music credit: "Carefree" Kevin MacLeod (incompetech.com)
 Licensed under Creative Commons: By Attribution 4.0 License
http://creativecommons.org/licenses/by/4.0/

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Transcript

SPEAKER_01 0:01

Hello, listeners, and welcome to Just Us, Before, Earth, and Beyond, where we talk about everything perenatal and community health. My name is Brandon Romstott, and I'll be your host for today's episode. I'm so excited about today's conversation, but please be warned, we will be focusing heavily on the community health piece of our mission statement. Specifically, we'll be talking about the role trust plays in shaping health outcomes and community health. Now, if you're a seasoned listener, we love ya, thank you for being here. And you already know that Just Us is a podcast that explores real topics and dives into what's what has happened, what is happening, and what can happen next in the health and healthcare spaces. If you're new here, don't worry, you're also very loved. We're glad that you're here and hope that today's episode inspires you to spend more time with us in the future. If you like what you hear today, be sure to hit that subscribe button so you get updates on when we drop new episodes. Feel free to leave us a comment or review. We read them all and we love to hear from you. Again, my name is Brendan Romstad, and I'll be your host today. Now, I work as the director of health communications for WNC Health Network, which is a regional public health nonprofit that exists to support people and organizations to improve community health and well-being across the westernmost 16 to 18 counties of North Carolina. As the director of health communications, my role centers the facilitation of a group called the WNC Health Communicators Collaborative, which is a group of over 100 health communicators representing a wide variety of public health and medical organizations, all working together to build communications capacity, expertise, and infrastructure here in Western North Carolina. Basically, y'all, I spend a lot of time talking to a lot of people about health. What makes health possible, and more frequently, what makes health impossible. And a really surprising through line of these conversations is the essential role trust plays in determining health outcomes. We know that trust between patients and their providers is the foundation on which improved health outcomes and medical satisfaction are built. And we're gonna talk in depth today about what trust means, how to build it, how to break it, and how we can strive to build more trusting and long-lasting patient-provider relationships in WNC. Here to help me have this conversation is my dear friend and colleague, Dr. Brian Hodge. I'm gonna go ahead and turn it over to you. Um tell us your story. How are you? How are you showing up today? Who are you, and why are you here to have this conversation?

SPEAKER_02 2:24

Yeah, I'm doing quite well today. I'm um, you know, so I'm a family physician by training. You know, I really got into the health profession primarily because I I really saw a lot of the inequities that occur out there. I saw that there were a lot of different ways that you can make a difference in people's lives by being a physician. And I really found a calling to be a family physician because I saw that as a specialty that really built uh longitudinally on relationships, um, that where you got to know your patients. And um, and so you know, I think that that discovery or that that moment for me probably was when I was in high school and I saw mentors that served in that role. I I could see how they they really felt good about what they were doing and felt like they could make a difference. I also saw how they were not just um distributors of medication, and we and we need distributors of medication and uh diagnosticians, but they were also educators. Uh, they were teachers. Uh people often ask, like, what would you have been if you weren't a physician? And I often say a teacher, and I'm really lucky actually with my role. I'm the chief academic officer here at Mayheck, and so I really look at workforce development through a more comprehensive lens, uh, really trying to figure out how we can identify people at multiple stages and encourage them to pursue a health career or inspire them to become a health professional. And so we have programming uh here in Western North Carolina that tries to engage middle school, high school students, help them imagine what it would look like if they became a physician, nurse, pharmacist, community health worker, and those types of things. And then supporting people actually throughout college and their undergraduate experience, providing the mentorship and the application support if they do choose to go into a professional career and applying to that next stage. And then we have a robust amount of residency programs or graduate medical education programs that help support physicians really learning to become board certified in their specialty, so family medicine, internal medicine, OB surgery, psychiatry. And that's really where they kind of hone their skills and develop the mastery. Uh and part of that is actually learning in place, learning where there are places of need, and also learning the attitude to be an effective uh clinician, which I think brings us to this conversation in many different ways, because inherent to that is how do you establish trust? Like how do you build trust and rapport at the bedside? How does that happen uh quickly? How does that happen over time? Uh, how do you leverage trust to actually help people through behavioral change to like not always even seek cure, but just actually help them manage and suffer less as they experience their life. And so I think that's one of the most beautiful things about being a physician. I I do think that uh I'm trust is really built upon the the sharing of information and the the openness to really see people how they are. And as clinicians, I I think that we we go through a lot of education so then we can apply the knowledge that we have uh to help inform people how they can live the happiest and healthiest life. Yeah. So I think I met meandered a good bit there. Um, but I think I got us to a place where we're kind of um grounding ourselves in in trust and this relationship that that I really um hold in the highest regard.

SPEAKER_01 6:08

I would say that you're right. I would say that you're right. Well, and also I think it's really impossible to have this conversation without meandering because Mayhec does so much. For those of you who are not familiar with Mayhec, um we are currently in Asheville in the main campus of Mayhec. And if you know anything about Asheville, I'm a I'm a native here, and we are all, everyone who lives here is like one separation away from knowing each other. And I have had so many friends, so many family members who come to Mayhec and have an extraordinary experience here. So I would just like to, I don't want to like toot your horn or like I don't know, inflate anything. And what I have heard is that Mayhek does a really good job of building trust into their patient-provider relationship a little differently than what I've heard from other providers. In fact, I hear from the public health side very often that folks wanted to get into healthcare because, of course, very much like similar to your origin story, folks wanted to help people, but they didn't realize that they were going to have to facilitate trust building as uh as a doctor. They thought that, like an education, they they often voice a sense of surprise when they're like, oh, I thought, I thought that because I have this level of expertise, uh, people would default to trusting me. And it sounds like you actually have facilitated an experience with your providers where trust is kind of baked into the system at this point, which I think is really fascinating and incredible. What do you have anything to add to that?

SPEAKER_02 7:38

Well, so so I think you know, we really look at you know how we train the workforce and uh we we look at what curriculum, what experiences kind of form who you are. Sure. And because we're not only serving the region and taking care of, you know, over 50,000 uh patients in a year with over 250 visits and all that, we're also training a workforce uh to be able to then go out and learn from their experience here and then be that much more impactful in their community. And so uh, yeah, the idea of like, how do you how do you train a physician that's graduated from medical school? How do you give them the skills that allow them to be really effective? And part of that is like, how do you organize uh outpatient visits so that you know you're allowing a patient to talk? I think the average amount of time that a physician will interrupt a patient is like less than 16 seconds or something like that. Um, and so, you know, I I think listening goes a long way. How do you make time in, you know, as you're trying to deal with uh their complaint to actually hear their story and to understand what matters to them. And th those are skills that like aren't necessarily in the medical texts, um, but are probably some of the most important uh skills that you learn through through experience. And hopefully you have the mentorship uh to encourage that as you go as well.

SPEAKER_01 9:06

Yeah, I hear you're saying that the bedside manner goes a really long way. So I think so too. Yeah. Well, I would love to I would love to kind of kick this conversation off um more formally, I suppose, um, with getting an understanding and kind of setting the stage for our listeners. What does trust mean to you?

SPEAKER_02 9:26

So trust means that people are in a shared space where they feel safe and they can exchange meaningful information with one another, and that that information helps them inform, you know, either their behaviors or uh what they hope to do, or potentially just influences um them to live their life differently. I mean, I I don't know if that's necessarily the Webster dictionary version of it, but that that's what it means to me. And and then it that that challenges me also to think about like what are the conditions of trust.

SPEAKER_01 10:00

Yeah, it's like it's like that's the question that like that that is the thread of yarn that unwinds the entire ball, right? Yeah, it's hard to it's hard to stay really concise with that answer. Yeah. So many things.

SPEAKER_02 10:13

So I I mean I I I think about like the relationships in the in the exam room or at the bedside. Um, but I don't think uh many of the principles are very different from how we establish relationships and build trust with one another in community as well.

SPEAKER_01 10:29

That is exactly what my next question was. Like, if you were to close your eyes and think about a relationship that has high, high levels of trust, I'm wondering that can be with a family member or with a patient or with a mentor or whoever you hold in high esteem and like really feel like your dynamic is trusting. What makes that possible? What are the ingredients?

SPEAKER_02 10:52

Yeah, so I think some of the things that are top of mind with that question are really um, you know, uh feeling like I'm gonna be listened to, uh, that I'm gonna be heard, and that um my that there's gonna be some level of empathy um and that with you know, avoiding uh kind of judgment. Um and then I I think the other condition many times can come in the form of just time. Like, and I think as you kind of share in experiences in your life, there are moments that are more conducive to building trust because they're they're such a big deal for you. So I think about like when you're hospitalized and really sick, like who is there for you and and how do they show up? I think about um, and and I'm really thinking about family and friends, honestly. Uh when you have the birth of your first child, like you know, that is that's such a special moment, and how you're supported during that time by people, how you're heard during that time by people, I think really can provide that groundwork. And I think you mentioned family, and I think a lot of people have both the time and the willingness, um, but not everybody does within their family, and I think we gotta we gotta be considerate of that as well. Um, and so when we look at our closest friends, I I think that when I think about them, I think they're they're people that can see me for who I authentically am. And they they're able to do that because uh they listen to me and they um have an open mind, and that we've like shared in some of these experiences, you know, notable um notable experiences that that help shape um kind of that bondage with one another. And so now I'm gonna try to take that to the to the clinical level. Well, that that is which which feels like more of a sterile environment a lot of times. Like, you know, it's not like sitting on a couch or on a on a porch. You know, Iro ironically, there are some clinics in our in our region that their waiting room is the front porch over to the river.

SPEAKER_01 13:02

Like Yes, we want more normalized sitting on a front porch on a doctor's office.

SPEAKER_02 13:06

Yeah, so I mean, those are going to be conditions that like really set the stage for trust uh in relationship. And uh, you know, I I think listening is is probably the the largest prerequisite in the in the exam room and at the bedside, and um really hearing a person's story, finding out what matters to them, and then really exploring, I think, what direction should we go together rather than I have this advice for you. And I think maybe the medical community hasn't always done the best job of engaging in that way, uh, because there have been hierarchical um considerations there. Um and I and I think there's a lot of lessons learned uh and as knowledge has been that much more accessible uh through the internet, through Dr. Google, and through AI, you know, I I think that people will have information and they won't necessarily know how it best applies to them. And I think that's when they'll seek out uh trusted relationships from family, friends, uh clinicians, uh nurses to help guide them on, oh, I I think that the chatbot told me this or Dr. Google told me this. What should I do? And I think there's always gonna be a component, uh a human component, where there's empathy exchange so that um that's gonna be helpful in in really uh leveraging uh uh the relationship and the trust so that it really allows people to see a path forward for themselves.

SPEAKER_01 14:46

Yeah, tell me tell me if I'm summarizing this appropriately. So foundationally, uh trust trust to you essentially sounds like what does it look like to be a good person? To be like what does it look like to integrate values of like joy into these relationships? Like joy is a value I think associated with trust, reliability, right? Sharing a human experience with someone, approaching uh approaching patients or the people in your life without judgment, um, really taking the time to listen and understand, much like you would with a with a friend. Is that what I'm hearing? I'm really grateful that you you summarized it in that way.

SPEAKER_02 15:28

And I would say as a as a diagnostician and a clinician, there is a component of diligence, empathy, and curiosity. Like I want to get to the bottom of why you feel this way. And because I get to share in this experience with a lot of other humans, um, it allows me to notice patterns and it allows me to help really figure out what could prescription do for you, what could counseling do for you, um, you know, what share what what decisions should we share as far as a treatment plan goes.

SPEAKER_01 16:03

I imagine that if I trust my provider, I'm more likely to tell them the truth so that they can diagnose me appropriately or they can we can have a really honest and open dialogue. Whereas if I don't trust you, I'm probably gonna have a lot of barriers up and and you're not gonna have reliable information to do your job well. I mean, it's so true.

SPEAKER_02 16:23

Yeah, um very appreciative that you said that. And I've been humbled by that. Like um, because I I actually, you know, I'm I mean, my self-image is that I I'm actually very trustworthy as a clinician and I'm good at listening. But I, you know, interestingly, I do group visits, and I am always amazed that when people are around their peers uh in a group visit setting, they actually reveal to me things that they've never shared with me after like working together for six years. Yes. And it it's always really the picture just got way clearer. Yeah. Oh my gosh. And and so um, and I think that's also a fascinating uh kind of model of care because it it doesn't always make sense that you would actually have more trust in in a conducive environment like a group visit where there's other strangers kind of all pursuing care together.

SPEAKER_00 17:20

Yeah.

SPEAKER_02 17:21

Um, so um I I think that I I'm really interested in how can the health system better create environments uh that are conducive of like, you know, sharing of facilitating trust. Yeah. Facilitating trust bi-directionally.

SPEAKER_01 17:37

Yeah, absolutely. Well, uh from there, I think the the next logical step is set the stage for us. What you sit at a pretty like high level across the region, working with physicians all the time. Uh what do we know, or what can you tell us about the current state of the patient-provider relationship here in Western North Carolina?

SPEAKER_02 17:56

Uh so it's it's still tremendously valued. And I think if you look at the studies, um, you're gonna see that post-COVID and during COVID, there was a degradation of trust, I think, in public health and health systems, uh, and in that patient-provider relationship. Um, and so even even though that has uh really dec you know declined in some aspects, um, I think that the provider-patient relationship is still something that has been preserved and and really um uh you know I think that's still the the territory where um we people are going to be influenced by. Because I think it it is really kind of that intersection of relationship and public health messaging. Um and so, you know, throughout the pandemic, I I think there were, you know, we really had to address being in a uh state of real uncertainty, and yet we, you know, the public health and institutes and uh the CDC, uh all those uh organizations really had to had to do something. And in the process of doing something and the vulnerability of just not knowing exactly how is this transmitted, uh, I mean, there's so many parallels to other other times that we've experienced. I think that that it it was a it was a blow to the the trust in the system as a whole. And I also think that like even without the pandemic, the health systems have not been trusted in the same way because they're they're more complex to navigate. And I think people still feel like they struggle to get the care they need, to get the access they need. Um, I mean, I'm humbled in the region because, you know, even though we really work hard to make sure that there's workforce, and we think that if we put workforce uh in all our counties that it's going to create access, like if you actually look at the WNC HealthNet uh data, um, you know, as far as the people, their perspective goes, um it's been more challenging actually for them to re receive care for urgent issues. And they they access is has been an ongoing challenge, which that that's been hard for me to wrestle with because I feel like we're working really hard to to create that workforce, yet it's not always equating to access for patients. Um, and I think we have to ask ourselves some hard questions on why that is and what what's at risk when we're not there for our patients, right? Totally. What's the cost? Yeah. Yeah. So like even though like that that's uh that creates some level of distrust if like, oh gosh, I don't feel well, and I called the office and I got to wait. I got a recording, I had to wait a long time. Um and I I ultimately didn't get what I needed. Um and then I ended up going to to urgent care or the emergency room, and that felt unnecessary, and then I'm sent a bill that was kind of disguised to me, and I really, you know, so I I think there are a lot of system systematic ways that we are probably also maybe not um encouraging trust as much as we could.

SPEAKER_01 21:13

Sure. Your answers have so much insight to dig into, like so much. Specifically around the current state of the patient-provider relationship. What's the story of the patient-provider relationship across the region? And I really love that you mentioned um in rural communities, I think you're absolutely right. Western North Carolina has some like very, very rural communities, and that requires a lot of nuance when you're talking about if I'm just providing access to care, is that enough? Uh, I'm I come at this from a communication standpoint, and we know that across the region, people like to hear messages from uh people who look like and sound exactly like they do. So I imagine providing health care requires. Requires some additional nuances, uh, very similar to that. That it's not like it's not just like, oh, we provided docs in this space. It requires so much more attention to detail than that. Well, I'm I'm wondering, there's there's a lot that we can talk about there, but like what yeah, where do you want to start with that one?

SPEAKER_02 22:17

Yeah, so I mean, maybe we'll start at the end there. So um I think when we talked about the conditions for trust, is uh it's it is I think it's proven that people have an easier time attaining trust when people have similar lived experience, when they may look like them or talk like them, um, and can relate to them. We're really talking about relatedness and and um I hope nothing more than that, right? And so I think that that can help. Um, but if we you look at the diversity that exists out there, like to think that, gosh, I you know, the only place I can have trust is when someone is like my exact profile. Like you know there are people that tr engage with you in a way that transcends that. So I think those are the skill sets that we want to make sure are taught as people are training. I think that our rural communities have especially been kind of the canaries in the coal mines for when there are access issues and when our system starts breaking down, they're usually the first ones to feel it. And that distrust uh goes a long way. And I think it has generational um challenges. Um, you know, I think about areas like Graham County, uh, where there are limited resources and difficulties getting access uh to same-day appointments. I think there is an urgent care that functions there. There's FQHC, and there's the health department, and a lot of entities uh that are really trying hard to be there, um, but they face workforce shortages that make it difficult to do uh what they want to do. And so I I mean I think there was one point where the highest per capita spend for Medicaid was in Graham County, and that was really fueled by people calling EMS and and uh fueled by people traveling outside of the county uh to an emergency department or to to another facility to try to get their routine needs met. And so when the systems start breaking down, they can start breaking down uh in ways that then that becomes the norm. So I think there's there's one aspect where um, gosh, we realize we're really not matching our resources with where the need is. And then I think there's also this other aspect that people give up on the health system being there for them. And so, you know, I've done outreach where I we really started looking at who are the people that end up showing up at the emergency room a lot, and what are the drivers for that. And as our program really got more and more mature, we realized that there was a whole subset of the population that wasn't showing up to the emergency room, that weren't established with primary care, that had all the same issues, whether it be substance use disorder, psychiatry, uh, mental health issues, yeah, like all of those issues, and that we're just living in isolation and um like suppressing them or trying to do the best they could without the resources. And so I think we have to really take a hard look at like what is our health system supposed to do? Um, and how can it be welcoming to all? Um, I think you touch on some real key points there with um people feeling that they're uh either talked down to, or like especially when we look at substance use disorder, um the stigma that goes along with that. You think we would have learned this by now, but I think we're we're continuing to work at it. Um and so um I think there are all sorts of individuals in in our communities, our neighbors, that that don't feel safe or don't feel connected uh to someone that can help them manage their health. And and I think that we as a society and a culture got to go somewhere with that and got to do what we can to make sure that we're getting better. Uh and I think that that helps it, you know, it it's helped by communication campaigns, it's helped by neighbors helping neighbors. It's it's actually like in many ways, um, in Western North Carolina, Helene brought a lot of neighbors together and people realized how much more they had in common. And I think that was a silver lining of this region really going through that hardship.

SPEAKER_01 26:54

Yeah, I I think one thing that Western North Carolina is is quite known for, and I'm curious about your reaction to this, is when there is a shared experience, we come together really, really, really hard. And I think Helene really demonstrated that. We are kind of isolated out in the West, right? Especially the farther west you go. So we've had to, for lack of a better term, we have to be really scrappy. We have to know each other. We are really well connected in these communities. And I I think that that's that social capital is a real gift when we're talking about mobilizing community and building trust. If we can tap into those networks of people and build trust with community voices and like really become, I'm I'm I'm stuck on this idea too of like another element of trust is two parts to this knowing and being known. Right? I think something that makes us feel really uncomfortable as people, like a shared human experience is stepping into the unknown. That is like famously, it's just like we're crawling out of our skin when we don't know what to expect. So if I'm wondering how that could apply to the medical infrastructure, how do we make the medical infrastructure in these rural communities more known so that people feel more comfortable, um, kind of like as a way to till the ground to get them ready to go into appointments or take care of their health differently. That's just something that I'm I'm considering or thinking about.

SPEAKER_02 28:29

Yeah, so I mean the the theme that comes to mind is how how do you make sure that uh we're we're proximal enough to the issues with our solutions. And I I would say this is probably like the the greatest strength of Western North Carolina, um, and it's probably been earned through crisis, right? I'm actually really happy that we landed on this place of like what are the conditions of trust? Like actually a condition of trust can be crisis, right? Oh, absolutely. Um and I I think we've experienced that uh repetitively here. Um But I I you know trust comes when you have that relatedness, and one of the easiest ways to have that relatedness is being close and proximal to one another and having that time together. So I I really do think that that translates directly into what we try to do with workforce development, make sure that we're training in places where you know you can go on to serve. And I think it also relates to like how should the system work better for people. It should, it should make everything possible that that makes sense be delivered locally. So like what are the what are the things that are most essential for you and your health care? Like you want to have a primary a relationship with a primary care provider, you want access to urgent issues, you know, and you want access to substance use disorder treatment. Uh, if you or one of your loved ones uh you know is inflicted with that, uh you want uh access to perinatal options for for family planning and if you're pregnant, you want those, you want those as close to home as possible. And I think if it's if it is close to home and it and it's those services are performed by someone that lives in community, I think a lot of magic can happen there. I think a lot of magic can happen there. Yeah, a lot of barriers can be a lot of magic, yeah. A lot of barriers can be uh, you know, bridged. Um a lot of obstacles can be bridged uh through those relationships because there is that that much more of a relatedness. Uh when you share it, you know, go into the grow the same grocery store, uh, when you potentially share in the same uh spiritual community or your children go to the same schools. I think there's so much power in that. Um as I'm saying that, I it it almost sounds old-fashioned. I know. I was just picturing like making house calls, you know.

SPEAKER_01 31:02

Yeah, yeah. Well, so which is kind of like the community health worker model.

SPEAKER_02 31:05

Like Yeah, a lot of uh community health workers have been doing this for ages. Correct. And so I think we can we can learn from them like who needs to be proximal, who w how do you leverage that trust? And and that really has um kind of spawned, like, oh gosh, there's so much more we could do uh by utilizing community health workers.

SPEAKER_01 31:27

Yeah, I uh yeah, amen. Uh thank you if you're a community health worker. You're an angel on this earth, yeah. Um I think something that feels really important to name, and and uh I just yeah, I'm gonna keep going back to this. It's like the strength of the communities in this region is really, really unbelievable. We saw this demonstrated really powerfully during Helene, and I think we may have seen it demonstrated by the threat of measles as well. Uh for listeners who may not know, um right over the border in South Carolina, there was a pretty sizable measles outbreak with over a thousand cases uh of measles uh experiencing lots of surges, big community spread. While in North Carolina, we only experienced 24 cases total and very light community spread. And I'm wondering if you could shed light on the story of that. What what do you what do you think was the difference? Did trust play a role in reducing community spread and impact?

SPEAKER_02 32:39

You did a great job kind of framing the question in some of the data, which is uh we know that viruses actually uh don't see county lines, they don't see state lines, and so um I think this was an another major threat both to our community um and to our health systems. Uh, and I think we, you know, on the heels of the COVID uh-19 pandemic, I think that we were well aware of all the different levels that we need to try to mitigate. And I I was particularly worried um with measles because if you looked at the counties that were in South Carolina that had the highest number of cases, they just happened to border the counties in North Carolina that had some of the lowest vaccination rates. That is correct.

SPEAKER_01 33:26

We were all panicking.

SPEAKER_02 33:28

Yeah, and I'm like, the universe is conspiring against us, right? However, I do think that there's a lot to be said about um, you know, I think we mobilized quickly. I think that we aligned on communication, I think that the health departments um did heroes work.

SPEAKER_01 33:45

Um my god, I love that term. I'm stealing it. Heroes work. Yeah. Unbelievable. The response was unbelievable here. Yeah.

SPEAKER_02 33:52

And because uh, you know, I think we take for granted um all the things that the health departments do, uh, but the messaging, the identifying cases, the tracking cases, and then just getting word out to all the different organizations and healthcare providers, you know, that to give us a really good sense of what the landscape is and what we can do to protect our patients and ourselves and our workers uh who are going to be at the front line. So I think that there was also just so much collaboration uh across counties uh and across the health systems that really speaks to the strengths, I think, of Western North Carolina.

SPEAKER_01 34:36

Yeah, I I really see the the public health community, I mean that's that's where I live, that's that's my home, you know, um, and the medical community. I've I'm not experienced across the country, but what I have seen being educated here and working in this region is that these niches of public health workforce and the medical workforce reflect the strength of the community and that closeness, that sense of like, that sense of community closeness and and reliance on each other. Y'all, we all know each other and we collaborate on a routine basis. Um, and I just think that that's really special and it's really unique. And I don't I don't know, I just see the scrappiness of our residents reflected in the scrappiness and the collaboration and the relational element of how we as public health and as medicine work together.

SPEAKER_02 35:34

Well, and I think I think there's inherent trust there. I think there's inherent trust there. It's a different, it's a different level and it's a different relationship and dynamic. At the same time, like you know, it makes me wonder like why is it there? And it's it's there because actually, like I think the the Western North Carolina is uh really blessed with the fact that they have um you know a lot of health providers that are committed to the area. And so they've been here a long time and they they network uh with one another. I'd like to think that Mayhek's been a major part of that, um, especially when a lot of our primary care workforce uh has trained here and has connections to Mayc. Um and similarly, I think the the health department community also um has a long track record with working with one another. And I don't think that um it should be underestimated how much those two work in tangent with one another, that there's trust there, and we have systems and mechanisms to actually reinforce what the other is doing. And we each know our role and how we can help one another out. I can't think of another decade that uh we've been challenged as much to really flex those muscles, right?

SPEAKER_01 36:51

Yeah, I'm like, pressure does make diamonds, doesn't it? Yeah, yeah, for sure. Yeah, I I mean uh when the public health responses and local health departments were kind of ramping up, and even in like, again, the the collaborative that I that I support um has representatives from hospitals, FQHCs, community-based organizations, local health departments all across the region. And the pressure to very quickly mobilize and stand up protective mechanisms and share reliable information about that outbreak, it was swift and it was essential that folks were able to, at least the communication staff that I support, were able to share the resources. So no one was having to recreate the wheel, right? Like if you sent out a school letter, like a notification letter in Buncombe County, Buncombe was sharing that with Clay County and Jackson County. And then whatever Jackson County was filming, if they were filming PSAs, that was being shared with everyone else on the collaborative as well. So we were, we have these like streamlined mechanisms for collaboration that make regional messages and awareness building and education really efficient here in the West. And that I don't know that that's true in some other places. And that's just really fascinating to me. I'm like, man, I love how the strength and the closeness of our communities is reflected in the workforce. Unbelievable.

SPEAKER_02 38:22

Yeah, and I love watching that. We have to we have to celebrate that. We have to celebrate that. Yeah, and it happens at the communications level, it happens at the hospital, um, the the uh community clinics, uh the health departments, all those different levels, but also like our our neighbors that are ambassadors uh for one another and and uh kind of reinforce those those thoughts. You know, it does also remind me of the prevention paradox, which, you know, uh I mean, this could have looked so much different. And the fact that it didn't uh is worth a celebration, and I think so many things within the system actually did go right because there was that collaboration, that trust. And the there was actually um, you know, an ongoing working relationship between all of those entities in Western North Carolina.

SPEAKER_01 39:12

Yeah. Yeah. I couldn't agree more. It was such a it could have gone very differently. Yeah. It could have gone very differently, and we're really lucky. All right, Dr. Hodge, we have talked at length about what builds trust, but I'm wondering what is your uh understanding of factors that undermine trust in the patient-provider relationship.

SPEAKER_02 39:33

Yeah, I think there's all all sorts of ways that uh we can go wrong. And I I think that uh most of the listeners can also recognize where other other parts of their life where trust has been compromised, and I I think you would see similar patterns there. Um but I do think of like a patient that I had, this was a patient with uh pretty advanced diabetes that actually did not really want to pursue using medications for that. And uh as a result of the way that he was treated, talked down to with his interfaces with uh the medical community, as a result of like the sense that he had that he was never listened to. Um, many times he didn't pursue care. And I actually like was able to hear his full story and uh also reflect with him that like, you know, we really don't have to agree. You know, this is your life, um, and I am here for you no matter how you show up. And so I think the more that we can create those types of interactions, the better off we'll be. Um I think that there's all sorts of divisiveness out there, you know, especially from a communications standpoint, that it's so easy to become polarized. And I think when you're polarized and when you're um never given the whole picture, um, I think that uh when we stop being curious, um I think those are all things that work against our ability to build trust from both directions. Um and so I mean, those are the things that come uh top of mind. And as I think back to that relationship that I had with that patient, like um really as a as a clinician healer, my my job was to be there for him no matter how he showed up. And I am actually confident that he had a better course because he had a trusted relationship, and there's some something therapeutic directly about that, even if you aren't, you know, getting out your pen and prescribing medications.

SPEAKER_01 41:47

So what I'm hearing you say is that, yeah, we've established that you are the gold standard of medical care. So thank you for that. And you're like, no, that's not what I was saying.

SPEAKER_02 41:57

Um I see that all over the place, actually, in Western North Carolina. Uh, you know, and I I think that as a as a medical community, like we inspire one another um to be better and to be there for our neighbors.

SPEAKER_01 42:09

Yeah. So uh well, Dr. Hodge, we are just about at time. Uh what do you want the listeners to take away from this conversation? What are some what are some one or two key points that you want listeners to take away from today's chat?

SPEAKER_02 42:25

You know, I I think we've hit on many of the points, but as we think about what's at the essence of trust and the relationships that matter, it really comes down to relatedness, uh, times under pressure, and probably times in joy uh with one another. And so I I think as as a community, it's it's always bi-directional. And I think health and wellness looks like a lot of things. And it's not just the relationship of providers with their um with their patients. Like it's actually our relationship with one another in neighborhoods. Um, it's our ability to be social with one another. That's you know, loneliness and isolation are probably the some of the biggest drivers of our health. So I I really think that there uh the vacancy um of uh not having trust or uh relationship with one another in our society and in our culture uh poses uh such a great health risk that I think I would encourage our listeners just to lean in, to be proximal, uh, to be there with one another and and really um try to not only um engage with one another, but also look for opportunities to bring others together.

SPEAKER_01 43:39

So yes. I'm hearing you say we can all afford to be kind, stay curious, and stay open with each other. Love that. Love that. Love that. Dr. Hodge, thank you so much for being here. I really appreciate you. It's been an honor and a lot of fun. Yay, good. Good. If you are seeking resources to find health and healthcare, check out the Find My Care WNC map. The objective of this platform is to provide communities with key information and tools that can enhance transitions, continuity, and access to healthcare services. Using the filtering function, viewers can identify a wide range of available services and their locations. Users can also request to add, delete, up and update resources so that the map is as accurate and useful as possible. We will leave the link in the show notes. Thanks for listening.