‘Good Morning, My Name is Aara’: Building Trust in Health Care

Jan 28, 2015, 8:00 AM, Posted by Aara Amidi-Nouri

Aara Amidi-Nouri, PhD, RN, is associate professor of nursing and director of diversity at Samuel Merritt University in Oakland, Calif. She is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2014-2017) and has served as a project director for the RWJF New Careers in Nursing scholarship program at Samuel Merritt University since 2009.

Trust. Our health depends on it, and so do our lives.

Our very first stage of personality development as infants starts with trust, according to renowned developmental psychologist Erik Erikson. A newborn’s basic needs—food, shelter, and clothing—are entirely entrusted to a caregiver, one who hopefully recognizes that he or she does not yet have an ability to shiver, sweat, or shed tears.

When caregivers are attuned to babies’ environments and hunger cues, they are able to meet their needs and build their trust in other human beings. When caregivers hold newborns close, they meet their need for love and affection, building trust with every heartbeat and with every breath. We are social beings, dependent on one another. We must trust one another in order to survive. It’s no coincidence that our pennies—our most basic form of currency—are engraved with that very word.

What happens when, instead of building trust, we create mistrust? What happens when we can’t trust our health care system or our health care providers—our own caregivers, the very people who hold our fate and our lives in their hands? 

Consider the Tuskegee syphilis experiment and the recent revelation about Henrietta Lacks, whose cancer cells, taken without her knowledge, led to critical medical discoveries but with damaging consequences for her family.

Consider the story of the Kennedy Krieger Institute, which in the 1990s allegedly exposed young African-American children to dangerous levels of lead to study its hazardous effects—a study that the Maryland Court of Appeals compared to the Tuskegee study.

Consider long wait times for care for critical medical conditions, and short health encounters with providers that often end with yet another prescription but no real solution.

And think about this story: A grandmother summons the courage to see a health care provider for severe back pain. Her blood work reveals high blood glucose, and a physician diagnoses her with diabetes, largely because of her risk profile: She is over 65, overweight, and African-American. Six months later, her diabetes remains uncontrolled and she gets a new diagnosis: inoperable pancreatic cancer. This woman was an acquaintance of mine, and her death a few months later was a stark reminder to her community that health care providers were not to be trusted.

Think about the ever-widening digital divide and the lack of high speed internet in certain zip codes. This divide grows wider thanks to our health care industry’s incessant desire to move to online scheduling, telehealth visits, and electronic health information. Just try to make an appointment by phone; a human voice is almost impossible to find in a web of endless voicemail loops.

In our quest to ensure that we have the right patient, simple greetings are replaced with scanning a code on a wrist band and a cold request for a date of birth 

As providers, we don’t give our patients warm greetings, the kind that can build trust in us. We let the plastic badges on our white lab coats make our introductions for us.

I visited a health care provider recently, and there were few introductions. My name was simply called out aloud in the waiting room, and I found my way to the hallway chair for the obligatory weight, blood pressure, and temperature measurements—all taken by a person who never told me her name.

How can our very basic human need for trust be met when this is how health care providers provide basic care?  How can we make trust a more important priority when we educate health professionals? How does trust begin to become as important or, dare one hope, more important than the technological imperative?

A Culture of Health is built on trust. As providers, we must take deliberate measures to rebuild trust with every encounter and in every classroom. Sometimes, building trust begins with something as simple as, “Good morning, my name is Aara. How are you today?”

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.