Trust is the basis where all kinds of relationships are built on. A review by Goudge and his team suggests that trust is generally understood to be “judgement in a situation of risk that the trustee will act in best interests of the truster, or at least in ways that will not be harmful to the truster”. According to Hall et. al, it is, “the optimistic acceptance of a vulnerable situation in which the truster believes that the trustee will care for the truster’s interests”. The key terms of the two definitions are truster’s interests and optimistic acceptance. Both of them have major significance in the pharmacy profession.
Trust plays a crucial role in healthcare settings. Though a direct relationship between trust and healing is not yet established, trust in the healthcare provider makes the patient obey him/her and hence adhere to the therapy. From the reports of FIP, patients marked greater satisfaction with treatment, showed more beneficial health behaviors and symptoms, and experienced improved quality of life when they had higher trust in their healthcare professionals.
Also, an optimistic thought of someone helping her/him recover will enhance the process of healing. Obviously, establishing this bedrock of trust is the first and foremost step that a pharmacist has to take in a healthcare setting. This broad and general fact can be scientifically explained by the ‘Placebo effect’.
What is the Placebo Effect?
The Placebo effect is actually a process of tricking the patient with a fake treatment and watching the outcome. A placebo is a therapeutically inactive drug that resembles the actual one in sight. The person here believes that he/she is receiving the real treatment rather than an inactive drug and the health professional can measure the psychological impact over trust of the patient in treatment.
According to some estimates, approximately 30 to 60 percent of people feel their pain diminished after taking a placebo pill. This is considered as the output of positive thoughts of patients, produced from their trust in treatment and its providers.
Is there a Scientific basis for ‘Trust favours Treatment’?
Oxytocin is produced in hypothalamus, and acts on areas of the brain responsible for social behaviours. Scientists hypothesize that oxytocin stimulates a trust response by encouraging “approach behaviour,” or reducing the natural suspicion we have to the social proximity of others. That is, a trust once established makes the people change their approach. This makes the difference between the treatment results of a patient with trust and a patient without considerable trust in pharmacists. A more favourable result can be expected from the first.
Trust is a Mutual Process
Trust can’t be a one-way philosophy. Patients should feel we trust them too. There are situations when we have to accept what the patient says, whether we believe it or not. Maybe, we can make them feel that we believe what they say, though we are not. Only choosing a way that favours their thoughts, that are impossible to correct, will work in such instances, especially in psychiatric patients.
Quoting an example from my experience, I can prove this. Years before, during a palliative care visit I had an opportunity to volunteer with a widow whose husband died a few years before. She was the first of the husband’s two wives. She was a psychiatric patient and lived with her husband in a small house. Over The days, her illness became complicated. Unfortunately, she had a severe fracture in a fall during this period and became bedridden. Husband married another woman and they three stayed together in the same home. The second wife took care of the first though it was a tough task to manage her. Even after the death of husband, they stayed together and the second wife continued looking after the first wife.
During our palliative care rounds, I met this patient and was going through the patient profile along with the nurse in our team. When asking about having medicines, our patient shocked me saying “My husband loved me more than his new wife, and hence he shared his food and medicines with me, not with her” I had a sudden paralysis from top to bottom and cried like “what are you saying, how can one share their medicine with other?” Our patient expressed her irritation by staring at me. I was new in the team, but the nurse, who already knew them, told me to keep calm. Though I acted calm, there was a storm passing inside me till we were leaving them. When I came outside, our nurse told me ‘It’s actually her husband’s trick to say it is his medicine, so that she will have it happily’. Trying to correct her will be no beneficial and accepting her the way she is found to show good results. Making the patient believe that we trust them is also a key factor.
An example of not trusting a patient, with untreated postpartum depression, by her husband who is also a physician, is narrated beautifully in the short story ‘The Yellow Wallpaper’ by great American novelist Charlotte Perkins Gilman. Disbelieving her and denying proper treatment eventually made her condition worse.
Do people really trust us?
According to FIP, pharmacists have consistently been named among the top five most trusted professionals. In the UK and Turkey, pharmacists stand second after scientists in people’s trust. But when it comes to India the place is around tenth. That’s why this article is approaching FIP’s statement in a critical way. The situation in India is different from the world scenario. People are not much interested in pharmacists, rather they look for doctors. Obeying doctors is their primary concern and they even negotiate with pharmacists for changing brands, higher costs and even for unclear prescriptions. Pharmacists in India have no role in medicine prescribing, and patient rounds in many health settings, even in tertiary care. Only a few hospitals have proper patient counselling units and drug information centres. All these were the things that give pharmacists a professional face and improve patients’ perspective.
Why does this happen in India?
Our modern medicine history begins with the British conquering of India. Since then, and more clearly, after independence, there has been marked growth in the pharma industry. India became the ‘Pharmacy of the world’. But still, the healthcare face of the Pharmacy profession which is regarded as less profitable (compared to industrial face) to the government but more favourable to the public stayed undergrown. Even the public couldn’t recognize the real healthcare heroes living among them. They never knew pharmacists were much more than a group of merchants, or chemical sellers. The pharmacists were also unaware of the suppression they were facing for long.
Even when the government and public are talking about health professionals, they keep the pharmacists outside and talk about doctors and nurses. No records of pharmacists recruited to Covid brigade are available. There was a crying foul of pharmacists many times to recruit sufficient pharmacists to covid centres, to avail vaccines for these frontline workers on time, to get paid favourable salaries…etc. No vaccination centres in Kerala (other states also) have a pharmacist. Asha workers are distributing medicines in communities and vaccination centres. Teachers have been distributing iron supplements and other tablets in schools since day immemorial. Media invites no pharmacists to discuss vaccines or medicines. From all these scenarios, it’s evident that even the Government here doesn’t trust their pharmacists, or they don’t have any idea about this health profession.
What can we do?
Installing patient counselling facilities to every smaller setting of pharmacy is the immediate step we have to take. Only a good interaction can make people realize what we really are. Communicating in a professional way will be more appreciable. Pharmacists, especially of community pharmacies should grow themselves to peoples’ expectations of a healthcare professional. For which they should stay updated in knowledge. Verbal, behavioural and social cues can contribute to a person’s expectations of whether medication and communication will have an influence.
Pharmacists with talent can also take chances to popularize this profession in social media which is the best medium to reach people nowadays. Talking continuously through useful videos and writings about us will catch attention.
The major step should come from the rulers and leaders to recognize these professionals wherever they deserve. They should be included in every discussion where medicines and health are the topics. They should be paid favourably.
Many of the rules and regulations regarding this sector are outdated. Steps should come from the responsible ones to update them to the time.
And every one of us should trust the pharmacist in us before anyone else.
Sachiko Ozawa, University of North Carolina – 2008
‘The role of Trust in Healthcare Settings – Does trust matter?’
International Pharmaceutical Federation – Pharmacist Day Posters and videos
Kendra Cherry – Psychological Rehabilitation Specialist
‘What is the Placebo Effect?’
Don Glass – Host and Producer of ‘A Moment of Science’ Radio
‘The Chemistry of Trust’
Charlotte Perkins Gilman
‘The Yellow Wallpaper’ – 1982
Paul Crits-Christoph, Agnes Rieger, Averi Gaines, and Mary Beth Connolly Gibbons
‘Trust and Respect in the Patient – Clinician Relationship’