Health and Poverty

Fostering Trust with Patients

Many patients have negative experience with the healthcare system, or with specific providers, for a variety of reasons. Many people living in poverty have reported negative experiences when visiting a doctor or other healthcare practitioner. Some believe this is due to having Medicare, or due to other indicators of their socioeconomic status (cite). 

NORC at the University of Chicago completed a survey on behalf of the American Board of Internal Medicine Foundation that found some reasons patients do not trust their healthcare providers include: feeling that their provider spends too little time with them, does not know them, does not listen to them, does not give them all the information, is too financially motivated, or does not make eye contact. This is similar but not the same as what physicians answered when asked why their patients may distrust them, which included high costs and challenges with insurance providers as well (NORC at the University of Chicago, 2021). 

Building nurse-patient trust

A study published in Nursing Ethics found the following aspects important to a building a trusting nurse-patient relationship: 

• Nurse availability and accessibility 
• Feeling emotionally and physically safe
• Feeling at home
• Feeling valued as an individual 
• Feeling adequately informed
• Respectful communication
• Getting to know a patient as a person first, not just a patient
• Acting as a patient's advocate (Dinç & Gastmans, 2013).

Cultivating trust and building relationships during a telehealth visit from the U.S. Health Resources and Services Administration discusses ways to plan ahead to gain patients' trust over a video telehealth appointment. 

• Appearances matter - patients tend to trust healthcare providers who dress professionally. 
• Portray a professional environment.
• Pre-test your technology.
• Eliminate disruptions.
•  Minimize wait time.
• Provide digital support.
• Make introductions and be casual.
• Acknowledge the patient's concerns.
• Be aware of body language, take time to listen, and express empathy.
• Bring in a translator if necessary, provide accessibility to all patients, and be culturally aware.

Uninsured Patients

In 2009, Drs. Robert A. Forester, MD, and Richard J. Heck, MD wrote a list of ways they help their uninsured patients. You can find their list here. They recommend:

• Helping patients through the insurance paperwork. Some people may believe they are uninsurable, when in reality they do not understand the system. 
• Explain costs clearly. Many patients avoid preventative medicine because of perceived cost, which can lead relatively minor issues to get worse over time to where they require more care or an ER visit. Explaining your costs versus more expensive later care as well as why things cost what they do can help patients with their health decision making.
• Take time and energy to try to solve or understand a problem before recommending expensive tests, when possible.
• Reduce unnecessary medications. This may include over-the-counter medications or herbal remedies. However, if doing so be culturally sensitive and respectful of why some patients may have chosen to take those medications or herbs. 
• Prescribe generic drugs.
• Use and recommend patient assistant programs.
• Perform some tests or services yourself that you may usually refer.
• Be aware of your community's social service resources and be in touch with them.
• When charting, keep a record of when services or tests are declined for financial reasons (Forester & Heck, 2009). 

Health Literacy

Help improve your patients' health literacy and your own. Health literacy is an integral aspect of holistic care, as it focuses not only on what a patient understands but also on how providers and the healthcare system operate. Preston Medical Library has a libguide on health literacy.

Other resources

Poverty and Health - The Family Medicine Perspective (Position Paper) from the American Academy of Family Physicians.

Guide to Reducing Hospital Bills for Lower-Income Patients from the National Consumer Law Center. 

Bringing the Benefits of Telehealth to Rural and Underserved Patients from the National Conference of State Legislatures - in Tennessee, as of 2022, telehealth calls must include video as well as audio unless they are for behavioral health. Calls may be audio-only only if the patient has no access to video.

Volunteer at a Remote Area Medical (RAM) Clinic: There are several RAM clinics in Knoxville and the surrounding area. RAM provides free medical, dental, vision, and veterinary care. Volunteers can help provide healthcare, but there are also volunteer opportunities for non-healthcare providers. 

How doctors can help low-income patients (and still make a profit), a TEDTalk by Dr. P. J. Parmar: Modern American health care is defined by its high costs, high overhead and inaccessibility -- especially for low-income patients. What if we could redesign the system to serve the poor and still have doctors make money? In an eye-opening (and surprisingly funny) talk, physician P.J. Parmar shares the story of the clinic he founded in Colorado, where he serves only resettled refugees who mostly use Medicaid, and makes the business case for a fresh take on medical service.