1 Deborah Gloria HLT-205 February 23, 2013 Dr.

Michael Rothrock Distrust Factor Among Specialized Populations Trust is the obligation or responsibility imposed on a person. By the same token distrust is to regard as untrustworthy or regard with suspension, to have no faith or confidence in. To build positive patient-provider relationships, recruiting and retaining patients for research projects, and work effectively with communities trust is essential. Distrust comes from historical trauma, and intergeneration wounding imposed on various minority populations (Kosoko-Lasasi, Cook, & O, 2009) One example of intergeneration wounding to American Indians was genocidal extermination by policies developed by the U.S. During this time it was believed that the only good Indian was a dead Indian (Saunders, 2008). Blankets were infested with small pox, mumps, measles and influenza. These blankets were given to the American Indians as a gift of of peace. American Indians immune systems could not fight these diseases. In addition, a bounty system was created to foster elimination of the Indian Problem, encouraging the killing of the Indians. When killed the body was brought to a specialized designated area and a bounty was paid. If there was no body that could be recovered, then the scalp was brought in and was paid for. The extermination was a dreadful period for the American Indian and its effects came in the form of intergeneration posttraumatic stress disorder. (Sanders, 2008). They encountered historical trauma in the 1950s where many American Indian women Were sterilized by the Indian Health Services. Women neither consented nor did their parents to this procedure. Although this is a reliable form of birth control, this procedure was considered

2 abuse and silenced the American Indian women to silence them with fear and shame. The women did not speak out for fear of losing their services with the Indian Health Services (Carpio, 2004). Due to these tragic events it shows us that trust is very important today. It is Crucial to have a patient-physician awareness and understanding of each other and their cultures. Building a relationship between a patient-physician is a trust factor that cannot be ignored. When trust is developed the patient mainly complies with the medical treatment and health is improved. Patients have a more open communication with their physician because of this trust and are able to open up and supply the physician with more workable knowledge that the physician can work with for the patients treatment, relating to health issues. Without trust patients may not access services at all, let alone disclose medically important information (Rowe & Calnan, February 2006) Trust requires greater communication skills on behalf of the physician. The ways physicians interact with patients has to change, providing information and participation in and supporting decision-making requires greater skills and may result in more consultation, and second opinions. It also depends on the patients willingness and ability to take a more active role in their health issues and whether they have the resources (finance, time, energy) to do this (Rowe & Calnan, February 2006). Physicians behavior can be associated with trust. Patients want to trust their physicians based on competency, communication, caring, and honesty. The physician can improve on getting the patients trust by being in touch with the patients health, knowing the patients medical condition and the ability to deal with the diagnosis, understanding of communication which is making sure that the patient, really understands what the physician is saying, fulfilling trust, which can mean something as simple as following up with lab/test results and relating these results to the patient, and supporting the patient in a non-judgmental and supportive way

3 and promoting continuity of health to the patient (Thom, Hall, & Pawlson, July 2004). Loyalty is another issue of trust. Just because a patient is satisfied with you does not mean they are loyal. Loyalty takes into consideration having to prove to the patient first you can be trusted. Way of improving loyalty can include have same day appointments available and making sure that the patient is not passed off to other physicians instead of seeing their own regular physician. Physicians need also to think of focusing of retaining younger patients for their practice. Making sure there are no long waiting times for patients. Good relationships need to be built between physician-patient to achieve loyalty. Physicians need to listen to their patients and even spending extra time helps. Apologizing to patients for being late goes a long way. By providing these things a patient can become loyal to a physician. Trust is fundamental to the patient-physician relationship. The importance of trust and failing to see the changing of trust relations could be costly and most important affect the health outcomes of the patient (Rowe & Calnan, February 2006).

4 References Carpio, M. V. (2004). The lost generation: American Indian women and sterilization abuse. Social Justice, 31 (4), 40-53. Kosoko-Lasaki, S., Cook, C.T., & O, R. L. (2009) Cultural proficiency in addressing health disparities. (pp. 37-52) Sudbury, Massachusetts: Jones & Bartlett Learning. Rowe, R., Calnan M. (February 2006). Trust relations in health care-the new agenda, The European Journal of Public Health, 16(1) (pp. 4-6). Saunders, A (2008). Creating justice through restoring tribal nations. The International Journal of Diversity in Organizations, Communities, and Nations, 8, (pp. 205-213). Thom, D., Hall, M., & Pawlson G. (July 2004) Measuring patients trust in physicians when assessing quality of care. Health Affairs 23 (4), (pp. 124-132). doi:10:1377/hlthaff.23.4.124