Thread by @Jessnimm

I think a lot about the time that a former colleague said to me about patient care (this was with respect to urine drug screens) - “trust is a two-way street.” Which, like many platitudes, has a nugget of truth. But, to me, it’s a huge part of what is wrong in SUD treatment. 1/

Because here’s the deal: I absolutely have to earn my patients’ trust. They have to trust that I have the training, background, and ongoing interest in updating my knowledge base to help them reach *their* goals. 2/

They need time to build a relationship with me - to learn how to share vulnerabilities with me and overcome the exceedingly rational worry about whether or not I am going to care for them as a whole person who matters. 3/

But my patients? They owe me NOTHING. They come to me of their own volition. I am neither their mother, their God, nor their spouse. They do not have to explain themselves an inch further than they wish. They have every right to decide what to share with me & when. 4/

Every visit, there are things I need to know in order to provide them with beneficial interventions. If there is information I need, I explain why I need it and how it could impact our plan forward. If they don’t want to give it, we. make. a. new. plan. 5/

There is no singular path to a goal. My patients understand that without complete information, there may be options that I’m unable to offer because of their safety. I respect their ability to and autonomy in making those decisions for themselves. 6/

Once we’ve reached the end of the information sharing phase on both sides, we talk about THEIR goal(s). Based on what they have shared with me and my clinical knowledge, I give them the pros and cons of EVERY option that is safe for them. 7/

Why I think some might be better or riskier than others. We talk about what I know about why certain approaches might work. Then THEY decide the next step. 8/

In practicing that way, I DO trust my patients, and I do my absolute best to show respect for their own knowledge every single time. 9/

But this idea that they have to “earn my trust” is nonsense. My patients get the standard of care every time, whether they tell me their life history or keep secret their affinity for mushrooms. Because THAT is the job. 10/10