How do you "trust" in 7 minutes?

Trust used to be automatic — a white coat, a degree, a firm handshake.
Not anymore.

In a world where average appointments last just seven minutes, how can any real connection be built?
In this episode, Dr. Fred Bagares shares a real encounter that changed how he views the physician–patient relationship. Through one tense appointment and a moment of silence that said more than words, he explores why trust has become the rarest, yet most powerful, currency in modern medicine — and how rebuilding it might be the most therapeutic act of all.

🕰 Timestamps + Key Themes

[00:00] The Encounter That Said Everything
A patient’s guarded body language and one honest question reveal how distrust quietly shapes the exam room.

[01:00] Seven Minutes or Less
Why today’s average appointment length mirrors a Starbucks transaction — and what’s lost when speed replaces connection.

[02:00] The Systemic Trade-Off
Healthcare rewards throughput, not presence. There’s no billing code for listening — yet it determines whether treatment even works.

[03:00] When Authority Isn’t Enough
Forty years ago, credentials guaranteed trust. Now, patients fact-check us in real time — and influencers fill the emotional gap.

[04:00] The Four Myths That Break Connection

1. Credentials equal credibility
2. More time means better care
3. Objectivity requires detachment
4. Patients can’t tell when we’re distracted

[05:00] The New Language of Trust
Why emotional tone outlasts medical details — and how warmth, not authority, keeps people engaged.

[06:00] Respect Over Authority
Trust is no longer given; it’s earned through clarity, presence, transparency, and reliability — one micro-interaction at a time.

[07:00] A Different Kind of Medicine
Inside direct care: how slowing down, thinking out loud, and clear follow-up create genuine partnership.

[09:00] The Shift From Guilt to Awareness
When a patient’s frustration becomes a mirror for systemic failure — and how it inspired Dr. Bagares to leave the insurance model.

[10:00] Trust as a Physiologic Force
Pain research shows that feeling safe literally changes how the body processes pain. Safety is chemistry — and trust is the trigger.

[12:00] The Long Game
You can’t build trust in one visit, but you can start it. The goal isn’t instant belief — it’s enough credibility to be invited back.

[13:00] The Reframe
In seven minutes, you can’t fix a life — but you can prove you care enough to try. That’s where healing begins.

If this episode made you rethink how healthcare relationships are built, share it with someone who’s lost faith in the system — or a clinician working to restore it.

#TalkingRehabPodcast #MSKDirectVB #TrustInMedicine #HealthcareReform #PatientExperience #FredBagaresDO #DirectCare

Transcript

0:01

As I entered their patient's room, I knew immediately that something was different about this appointment. The body language of this particular person told me everything. They sat fairly rigid, shoulders turned slightly away. Their gaze was fixed on some invisible point past my left shoulder. The room felt dense with unspoken frustration. I greeted them and I got a mechanical nod. My opening questions received one word, responses delivered like facts being entered into evidence. Finally, I shifted gears entirely. So what brings you in today? He said my primary care physician said that you can help me, but I'm guessing you'll tell me the same thing the others did. I didn't have a clever response ready. I really didn't wanna take the bait. Instead, I asked what felt like a very honest question. I said, if that's true, then what made you schedule this appointment today? This was followed by complete silence. Not really the contemplative kind, but of one of exhaustion, the kind that comes from frustration and bad experiences. If anyone has been to an insurance based clinic, this will not surprise you. In this week's episode, we are going to discuss the value of trust in today's healthcare relationships, and how to build it. I'm Dr. Fred Biris, and this is The Talking Rehab Podcast. Quick favor, before we dive in. If this podcast has changed how you think about your body or your recovery, hit that subscribe button. It's free. It takes two seconds, and it's how we keep bringing you these conversations every week. No fluff. Just real talk about what actually works. Thanks for being here. Now let's get into it. The typical medical appointment today runs about seven minutes. That's seven minutes total. Starbucks baristas are given about four to seven minutes to prepare a complex drink order like a latte. They even set a goal of four minutes for mobile orders. Now, think about that. This is an exchange of goods without any human connection, and four to seven minutes is acceptable. As physicians, we're supposed to be able to establish a rapport, understand complex histories, arrive at accurate diagnoses. Create actionable plans all while the clock spins towards zero. Here's what makes it worse. The patient likely waited 45 minutes before I walked through the door. They've already repeated their story to multiple staff members. By the time we meet face to face, they're wondering if anyone's actually going to absorb what they're saying. modern healthcare rewards, getting people through, but not the actual depth of the relationship. There's no billing code for establishing a human connection. There's no checkbox in the electronic record for quote unquote actually listened yet. Here's the uncomfortable truth. Without establishing trust first, nothing else matters. The most evidence-based treatment plan becomes worthless. If the person receiving it doesn't believe you, understand their situation. 40 years ago, a physician's recommendation carried unquestioned authority. Today's landscape looks radically different. Medicine was operated on different principles. The credentials gave automatic trust to the public. Our commitment to studying medicine, which in my case was an additional nine years after college, gave us some amount of credibility. However, that world is gone. Now patients leave appointments and immediately access countless online resources, some from legitimate experts, others from persuasive personalities who've never treated a patient. The quality and education varies oddly, but here's what those online voices often do better than us. They create an emotional connection. They look directly into the cameras and say things like, I understand exactly what you're experiencing. Let me share what worked for me. They're also very accessible 24 hours a day. There's some sort of online content that relates to your story. Meanwhile, healthcare providers, despite years of intensive training, might keep patients waiting, then deliver hurried consultations before rushing to the next appointment. When patients increasingly turn to internet sources over medical professionals, it's easy for clinicians to feel frustrated, but we need to acknowledge our role in creating this gap. We stepped back from emotional connection and others filled the vacuum and the increasing administrative burden of healthcare. We lost that emotional connection and others filled the void. Unfortunately, medicine physicians especially keep stumbling over the same obstacles. First, we continue to assume that credentials equals trust degrees, open doors, and they certainly mean something, but they don't keep people engaged. Trust requires something beyond certification. The second is we often play the blame game on time constraints. We tell ourselves we'd connect better with more minutes, but patients aren't demanding longer appointment times. They're asking for full attention during whatever time exists. They can sense when we're simultaneously in the room and mentally somewhere else. Third, we confuse objectivity with emotional distance. Medical training emphasizes clinical detachment, but detachment without warmth reads as indifference. Patients remember emotional tone far longer than specific diagnostic details. That patient would cross their arms, didn't need another physical examination. He needed someone to pause long enough to acknowledge his experience. Most of us entered this profession wanting to help people, not process them, but the current healthcare system is designed for volume and not quality. Healthcare workers simply have to survive through speed. Eventually, you start viewing patients as problems requiring solutions rather than humans carrying stories. Sure the faster you move, you can see more patients. However, how many of them are going to come back and see you? How many are going to be compliant with the treatment plan that you hurly gave them? Trust is the return on your investment. When I asked again how I could help, the patient's response was barely audible. He said, honestly, I don't think anyone can. That sentence resonated long after the appointment ended. It's the sound of accumulated disappointment. The voice of someone whose pain became invisible within a system that made them feel interchangeable. Unfortunately, I've heard this tone before, multiple times a day. From his perspective, I wasn't an individual. I was just another representative of an institution that had repeatedly failed him. The hardest part, his perception wasn't entirely inaccurate. He wasn't just skeptical of me personally. He was very skeptical of every provider who looked at the screens more than their faces who'd promised follow up, which never actually happened, and who gave their treatment plan with one hand on the door handle. Trust building has fundamentally changed. Again, four decades ago, authority grant generated trust. Today, it's really about authenticity. Patients aren't primarily scanning for credentials anymore. They're reading subtle signs. Did you genuinely listen? Did you acknowledge their frustration instead of dismissing it, did you actually read the chart before walking into the room? These signals can't be manufactured. This explains why influencers and wellness coaches connect so effectively. They've mastered the emotional vocabulary of reassurance. It's a language that healthcare has largely forgotten. Modern trust depends on four elements. Clarity, communicating plainly. Avoid hiding behind technical terminology. Presence. Giving someone complete attention during the allotted time. Transparency, acknowledging uncertainty. It demonstrates humanity rather than weakness. And finally, reliability. Honor your commitments, even the small ones, execute these consistently and even brief appointments. Feel respectful. Respect, builds trust more effectively than authority ever could. However, I can change how those minutes feel. Now that I'm in my direct care practice, I have complete control over the experience I deliver to my patients. Sometimes I begin with stillness. As soon as I enter the room, I face the patient directly. I don't type on the computer while I'm actually talking to them. I allow them to speak first, those opening seconds, establish the entire tone of the encounter, Sometimes I verbalize my thinking process I believe this demonstrates to the patient that I'm actually thinking of a customized treatment plan rather than just some sort of cookie cutter approach. For example, here's what I'm observing. These are the possibilities I'm considering. Here's what we'll investigate first. This approach includes patients in clinical reasoning rather than excluding them from it. I try to conclude with precision. I summarize the next steps, clearly repeat timelines, and provide something concrete to remember. This type of clarity generates confidence. even though my visits are now 60 minutes it's not necessarily about the duration, it's about the intentionality of the actual visit. Presence is a learnable skill that improves with practice. That appointment taught me something uncomfortable. His distrust was a reflection of the systemic failures. At that time, I was still working in an insurance based clinic, and it made me feel like I was part of the problem. Every bit of his frustration aimed at me was actually a target for the bigger system that had down his faith, rushed visits, unanswered communications, medical bills that didn't make sense. That day I stopped defending the healthcare system and simply listened by the appointments and his posture had shifted slightly. His arms still crossed, but resting differently, and he was certainly less defensive. This whole experience made me question if the current system I was in allowed me to be the best physician I could be. Ultimately, this is why I left the insurance based model and opened up my own direct care practice. I'm so very lucky that my community has been supportive and people have continued to follow me into the next phase of my career. I truly appreciate everyone that has led me to this point. Rehabilitation is a long process. There isn't a pill, injection or surgery that makes this process shorter. It's a time investment for both the patient and the physician. When patients trust the treatment plan, their movement patterns also change. Their bodies relax they begin exploring movement rather than guarding against it. The physical mechanics followed the mental shift. Pain research supports this. The nervous system processes signals differently when feeling safe. Trust literally alters the physiology. When asked about my most powerful therapeutic tool, my answer remains the same. It's trust. I can't claim I solved the patient's problem during our initial meeting. I know I didn't, but I did initiate a different type of dialogue. Over subsequent visits, he began sharing more, not just about his physical symptoms, but about underlying fears. work concerns, feelings of being disbelieved. Doubts about his ability to ever recover. These conversations never appeared in the medical records, but they transformed his care trajectory. Eventually, he improved, not because I discovered some novel treatment, but because he finally trusted the process enough to maintain the consistency towards our treatment plan. That's the nature of trust. You can't construct it completely in one appointment, but you can establish foundations and brief encounters if you use that time thoughtfully. Today's patients have unprecedented information access, but information without trust is just noise. We can't expect people to follow guidelines based solely on our credentials. As I said, authority might have worked years ago, but today. It's about humility, consistency, and humanity. when someone asks how to build trust in a seven minute visit, my response is straightforward is that you can't, you have to establish the first layer and you have to encourage them to return so that they can start to believe that you actually want to help them. Trust has to be built. In order for trust to exist, a relationship has to be established, and you simply can't do that in seven minutes. If this perspective shifted how you think about healthcare relationships, share it with someone who's lost confidence in the system. Or a clinician working to restore it. Thanks again for listening. Take care. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.