Category: Guest Blogs

Trust in health care systems is necessary to address racial disparities in hypertension control

Posted August 19, 2021

The Kaiser Permanente Health Care Program has historically had a special relationship with the African-American community. Part of this relationship dates back to the early years of World War II. In January 1942, as the American merchant marine fleet was being decimated by Axis submarine attacks, President Franklin Roosevelt called upon the industrialist Henry J. Kaiser to rapidly organize to produce replacement ships, which later became known as “Liberty Ships.” By June, Kaiser had organized a force of over 90,000 workers and was producing ships in Oakland and Richmond, California and Vancouver, Washington.

Many of these men and women were African-Americans who had migrated from the South in search of work. They weren’t eligible for military service at the time, and Kaiser was seen as trusted figure among working people. In the end, these ships and the people who produced them were vital to our ultimate victory in the war.

In recent years, Kaiser Permanente intensified its focus on control of hypertension. Hypertension and its sequelae are more common among African-Americans, especially men. And most studies have shown poorer control of blood pressure among African-Americans than in other racial groups. In seeking to address this disparity among its own members, Kaiser Permanente needed to deal with the prevalence of mistrust of American health care among African-Americans, particularly because memories of the Tuskegee “experiments” persist.

In 2000, Kaiser Permanente developed a large-scale program to improve blood pressure control for all of its members. By 2010, despite great general progress, it was evident that even in Kaiser Permanente’s pre-paid system, African-American members still had lower control than members of other racial groups. So in 2010, Kaiser Permanente instituted the Equitable Health Care Outcomes Program (ECHO). One of the first priorities was to once again address the disparity in hypertension control for African-American members. ECHO is a multi-part program, one aspect of which is outreach to the African-American community through education and culturally appropriate trusted communication techniques. By 2014 the disparity in hypertension control had been halved: from 8.1% to 3.9%. An independent analysis of preventive services in Medicare Advantage plans, published in the same year, showed no racial disparity in hypertension control in Kaiser Permanente. This was not the case in the other plans studied.

There are already indications that hypertension control levels among all racial groups slipped during the COVID-19 pandemic. Equally worrisome are reports that COVID-19 vaccine acceptance among African-Americans is low, again because of distrust of the heath care system. Now is the time to begin anew, to organize systematic coordinated care and communication processes tailored to the African-American community to increase their trust in our health systems. We must replace the toxic legacy of Tuskegee with new examples of health care equity for all, and embed equity in our shared consciousness and consciences.

Dr. Crosson worked as a practicing physician and executive for Kaiser Permanente for 35 years, including 10 years as the Executive Director of the Permanente Federation, the national physician component of Kaiser Permanente. He subsequently served as a Group Vice President of the American Medical Association and as Chairman of the Congressional Medicare Payment Advisory Commission (MedPAC).

My patients don’t trust the health system, so why should they trust vaccines?

Posted August 09, 2021

I work in a large safety net hospital in Boston. Early in the pandemic, when all of the primary care clinic operations were closed, I began to do COVID-19 screening in our Influenza Like Illness clinic (ILI). Unfortunately, we had few test kits available at the time, which meant testing only the highest-risk individuals. I remember having very difficult conversations with patients about why I couldn’t test them, even though I knew there were drive-in clinics across town testing any patients who came through. Fast forward to the availability of COVID-19 vaccines: we now have an abundance of vaccines in stock but face a very large minority of patients who deliberate whether or not to receive them. The question that I heard once – but I suspect has been voiced multiple times – is: “You wouldn’t test us when we asked to be tested. Now you want to give us something we don’t know the long-term consequences of?”

We’re struggling to vaccinate all of our patients (many of whom are at high risk of serious COVID-19 illness) because there is clear lack of trust in the health system to do what we clinicians believe to be in patients’ best interest.

I’m reading Medical Apartheid, a book written in 2007 by health and science writer Harriet Washington, who chronicles hundreds of years of medical mistreatment and involuntary experimentation on African Americans. Considering this history, I fully appreciate why our patients are very ambivalent about something many physicians see as potentially lifesaving. Most everyone is familiar with the Tuskegee Study, a federally sponsored study of the natural history of syphilis that ran from 1932 to 1972 in which treatment was withheld from a cohort of African Americans who had been told they were receiving treatment. What many people don’t appreciate is the long history of enforced experimentation on enslaved people in our country, including surgical procedures (without anesthesia) by some of medical history’s “giants.”

So how do I, as a white male physician with clear privilege, establish trust with my patients so they will accept the vaccine that I believe could save their lives as newer, more deadly variants come into our community? A few of my patients have told me that my recommendation is sufficient for them. But I most often hear “I’ll wait and see.”

My institution is working diligently to identify ways to engage patients in this conversation and move them from ambivalence to acceptance, but it’s difficult. Even our clinicians of color are struggling with this. We all know that lost trust is hard to regain. It begins when all patients feel welcome wherever they go for care. All patients need to feel that they are heard and that their concerns are validated. There also needs to be a universal commitment to eliminating racism from health care. This won’t happen overnight, but every institution needs to start right away. The next pandemic is not far off.

Dr. Tulsky is a primary care internist at Boston Medical Center. He also serves on ABIM governance as the chair of the Internal Medicine Specialty Board and chair-elect of the ABIM Council.

Public safety flags in medical records – the text, subtext, and repercussions

Posted August 05, 2021

“Assaultive: Patient attempted to strike a nurse in the face with his fist. Plan: Notify Public Safety when patient is present for treatment or services. Public Safety will work collaboratively with clinical/administrative staff to determine appropriate action plan (i.e. patient-safety search, extra patrols, short-post, etc.) when at all practical.”

This could have been my father. In a fit of delirium near the end of many years struggling with early onset Alzheimer’s disease, he was uncharacteristically assaultive to my mother during one of her visits, pushing her to the ground and pulling her hair. I don’t know if a similar public safety alert is highlighted in yellow in the corner of my father’s hospital chart, but it stung to read the alert about my patient, Mr. S, and imagine the assumptions another provider might arrive upon when scanning the chart. Or to envision a random “patient-safety search” launched against Mr. S at an outpatient follow-up visit.

Like my father, Mr. S was a gentle giant with an easy-going and humble air about him. That was until sepsis, strokes, and uremia from missing dialysis due to line access issues left him utterly confused about his surroundings and distressed to the point of trying to flee, culminating in the aforementioned event. Thankfully, a combination of antibiotics and hemodialysis delivered Mr. S out of his delirious agitation within a day or two. But I worried that this written notification could have longstanding and potentially dangerous health effects for Mr. S.

I did not have the same concerns for my father. My father was a white man and Mr. S is a Black man. My parents and I have had the privilege of navigating the hospital system and the outside world without constant concerns about being mislabeled as public safety threats. 

When I wrote the administration to dispute/amend Mr. S’s public safety flag, I was told that the public safety flags are an “objective documentation of a safety event” and not meant to be punitive. But there are many decisions and biases that enter into how an event is reported, be it in a public safety flag, in a patient history and physical, in a newspaper article, or in a textbook. Deciding what context to include or exclude is one factor that shapes the narrative. Moreover, the flag system may not be intended to be punitive, but the recommended actions (searches, patrols, and short-posts) have toxic effects on a person’s trust of the medical system and clinicians within it. A letter from a group of sickle cell clinicians at my institution documented several instances where Public Safety’s involvement triggered by the flag system led to humiliating and dehumanizing experiences for Black patients, including seemingly unwarranted physical searches and escorts. Mr. S is not a public safety threat and I will keep advocating for his flag to be removed.  

Public safety flags are commonplace across electronic medical systems in the United States. I fear that these flags can be weaponized in the way that a call to 911 in the outside world can be used to endanger a person of color. Are the public safety flags making the medical community – both staff and patients – safer? Or are they perpetuating systemic racism within a setting intended to care?

Alyse Wheelock, MD is a second year fellow in Infectious Diseases at Boston Medical Center. Her research interests are in Chagas disease and other tropical diseases affecting immigrants and refugees in the United States.

Can you see me?

Posted July 29, 2021

As a child, I was taught that we dress in our Sunday best when going to the doctor. Why? Growing up, we were told stories of health care practitioners mistreating patients based solely on their appearance, or even the neighborhood they came from. So, if we wore our very best clothes, then maybe…just maybe…we might be taken seriously. We might be seen, heard and trusted as patients. And in turn, the likelihood of being mistreated subsided.

Each of us has, at our deepest core, the need to be seen and heard. We want our experiences validated, and we want to know that our voices matter. But what happens when you are not seen or heard? What happens when individuals, organizations, or even professionals don’t see you or don’t hear you? 

In the last year, we have seen the centuries-long disparities in health care further exacerbated by the COVID-19 pandemic. We have watched in real time how the pandemic disproportionately impacted Black, Latino, and American Indian/Alaska Native people with significantly higher infection rates, hospitalizations, and deaths. What is clearer than ever is that health is foundational and anything that makes it harder for us to get healthy, stay healthy, or recover when we’re sick will inevitably widen the longevity gap.   

Several months ago, my primary care doctor referred me to a specialist. The specialist was nearly two hours late for the appointment. When he finally entered the room, he quickly asked me a series of questions and, two or three words into my answer, he cut me off and told me what he thought was going on because he had “seen” previous cases like this. I barely got a word in. As he continued talking over me and at me, his phone rang. He picked it up mid-sentence and started talking about another patient to the person on the line.

Following their conversation, he returned his attention to me and picked right back up where he left off. The entire encounter was rushed. He asked the questions and seemed to have all the answers – all because two words into my visit he decided he’d “seen” this before (even though I was a brand new patient). At the end of the appointment, I did not feel seen. I did not feel heard. And I had no sense of trust. Competency and credibility are one thing. But there is no trust when there is a lack of empathy, communication, and eye contact. Patients can and sometimes do leave a doctor’s office scared of impending test results, or nervous about a diagnosis. No one should have to leave a doctor’s office feeling devalued, disappointed, angry, and discouraged. 

It’s easy to look at disparities in health care as a crisis that is too big to solve. It’s not. Rather than thinking about overcoming these obstacles as a measure of success, we need to think about removing or preventing these obstacles in the first place. As health care professionals, simply taking the time to make patients feel seen and heard will build trust. You’re the ones on the front lines, seeing those who are hurting, listening to a list of symptoms, examining the situation, and solving a problem. 

With trust, patients will have the ability to make the best decisions for themselves and their families. It won’t matter if physicians see us in our Sunday best or in an exam robe. If we foster trust, we’ll see each other as human.

Jean Accius, PhD is senior vice president for AARP Thought Leadership and International Affairs. His areas of expertise include aging, caregiving and long-term care policy.

We must create a safer and more equitable training environment for clinicians

Posted July 26, 2021

During intern year I introduced myself to Mr. Smith (name changed), an older white man.

“Hello I am Dr. Adetoye. I will be taking care of you during this hospital admission.”

When the attending led us back to the room for team rounds, Mr. Smith addressed me as a nurse.  The word hung in the air, but no one, including the white attending physician, addressed it. The intersectionality of being a woman and a woman of color meant that I was unsure which had triggered this comment, but I was uncomfortable either way.

I wanted to talk with someone who would understand. But in my large department, there were only two Black female physicians. I was a new intern, and I hesitated to burden them. I did not want to add to their ‘minority tax’ burden as the only Black woman on faculty. So, I kept it to myself.

In my last year of residency, I was working in a hospital in a predominantly white rural community. While writing patient notes, I overheard two men and a woman outside the room discussing whether it was appropriate for police to kneel on George Floyd’s neck when he was resisting arrest. They agreed it was, though the woman felt he should not have been allowed to die. When I stepped into the hallway, the two white security guards and white nurse that had been conversing stopped abruptly and watched me pass. I kept walking.

Down the hall, I passed a Black security guard and impulsively thanked him for being there. He said, “You are welcome, Doctor. Things are crazy out there. I will be here all night. If you need anything, do not hesitate to ask.” I thanked him again, slipped into my call room, and began to cry.

As the sole Black resident in this hospital, I was afraid and stunned. How could the staff that I relied on discuss the merits of murder? This time, I talked to my residency leadership. To my surprise and pleasure, they were concerned and responsive, and we worked on ways to improve the climate at the hospital.

We cannot assume that the day-to-day experience of seeing patients is uniform for all. We know there are better patient outcomes and patient satisfaction with racial/ethnic congruence between patients and clinicians. The programs that train young physicians must take the lead to create a safer and more equitable environment for all. This can be done by taking several steps:

  1. Understand the communities where trainees work, identify potential challenges, and communicate these with trainees.
  2. Make clear that discrimination will not be tolerated by the program.
  3. Educate staff and faculty about these experiences and teach them to recognize and address microaggressions and support trainees.
  4. Provide time for faculty of color to serve as mentors so minority trainees need not seek this on their own.
  5. Institutionalize these policies so they are not dependent on the good will of one individual.

We can do better. Increasing medicine’s physician diversity and supporting trainees with these difficult experiences will prepare us all to better care for the world’s diverse patient population.

Dr. Adetoye is a Clinical Lecturer in the Department of Family Medicine at the University of Michigan. She attended medical school at Michigan State University and completed a residency in Family Medicine at the University of Michigan.

Make changes together to build trust

Posted July 22, 2021

Engaging and sustaining patient and community relationships in health care and health systems can prove challenging, but when health care is practiced in a culturally responsive manner, results can be both rewarding and beneficial to patients and clinicians alike. By utilizing a predetermined safe space for discussions and personal sharing, patients and relevant stakeholders (including front line staff and clinicians) are better able to capitalize on opportunities to listen and learn from one another.

Working together to develop and set terms of engagement can help frame how these discussions can move forward in an inclusive way – where all parties participate in a trust-building decision-making activity.

To facilitate such an activity:

Sacrifices will be made, and barriers will be dismantled, while paving relationships and determining together what trust in health care can be. Trust will likely be defined differently by each participant during your inclusive engagement activity. Make the time, be open for frank discussions, and open your heart to build trust and respect with each other. We are only humans after all.

Janice Tufte resides in Seattle and is a patient collaborator involved with health systems research, evidence production, clinical practice quality improvement and human readable digital informed knowledge generation. She recently co-authored a paper currently under review with the Journal of Health Design that discusses the importance of collectively designing research and is working with AcademyHealth’s Paradigm Project in developing a new research protoype.  Learn more about Janice at

My doctor judged me by my appearance

Posted July 12, 2021

In college, I took a sociology class on “Stigma and Social Deviance” and one of the assignments was called “Dress Different Day.” Each student was to spend an entire day in attire that would likely be stigmatized in our community. For example, my close friend Pam put a pillow under her sweater to feign pregnancy and walked around smoking all day. She’s since quit. The rule was no matter how uncomfortable you or others became, you had to keep the assignment a secret.

I raided my closet, borrowed an item or two from friends, and decided to spend the day in full-blown ‘club kid’ regalia. (Here’s a Pinterest page if you’re unfamiliar with this 1980s/90s NYC phenomenon.) To be honest, this was only a small enhancement of my typical going-out-to-the-club gear, but it was certainly new for my daylight hours!

After I laced up my platform boots, I realized I had my annual physical at my university’s health service that morning. So, I flung my tiny, spiky backpack over my shoulder and headed over. The waiting room was uncomfortable, but bearable – quick glances, furrowed brows. Triage went well; the nurse was unfazed. I was feeling OK until the doctor came in. She stopped short. She blanched. She looked at my makeup, my piercings, my pleather, and then she wouldn’t make eye contact again. She struggled with her questions. I could feel her discomfort as she examined me. Our mutual discomfort was palpable. I became angry – really angry.

Before I left, I broke character (and the assignment) and filled her in. I needed her to hear just how her behavior had affected me, that she was literal proof of the value of this assignment. Her response? “Oh, thank goodness. We just don’t get people like that here.” Did I mention this was NYC? They most certainly did see people “like that” every day.

It was 25 years before I engaged a primary care physician who wasn’t explicitly a member of the LGBTQIA community. My trust had been totally broken – and it’s not totally repaired.

Philip M. Alberti, PhD, is the Founding Director of the new AAMC Center for Health Justice and has spent the last 20+ years collaborating with local communities and the multiple sectors that serve them to build an evidence-base for effective programs, protocols, policies, and partnerships aimed at eliminating inequities in health.

The U.S. boasts some of the most advanced health care in the world. So why can’t some people find care in their own backyard?

Posted July 09, 2021

Several years ago, while working in the safety net system for Louisiana, I received a call from the medical director at a small rural safety net hospital, who needed help to urgently transfer a patient for life-saving treatment. 

The patient was a 45-year-old man who worked in construction for a small firm that did not offer health insurance. He was being treated for an infected heart valve when he suddenly developed altered mental status. A CT scan showed a subdural hematoma, a condition that is treatable with prompt neurosurgical attention. Regional hospitals, including some with available operating rooms and willing neurosurgeons, refused the transfer because the patient was uninsured. The medical director called 17 hospitals that day in a desperate attempt to transfer the patient without success. The patient died later that evening. 

This occurred during the national debate about the passage of the Affordable Care Act (ACA). Several months after the patient’s death, I called his mother to ask if I could tell his story to demonstrate the hard consequence of being uninsured. She agreed (and subsequently testified at a state legislative hearing) but quickly became hesitant. “This is not about Obamacare is it?” she asked. “Because we’re against that.” The abhorrent performance of the health system earned her mistrust that day and that mistrust extended to the federal program that would have literally saved her son’s life. 

While the number of similar cases is no doubt lower in the decade since the passage of the ACA (and the expansion of Medicaid by 38 states and the District of Columbia), 30 million people in the U.S. remain uninsured. Access to health care remains largely a factor of geography for many of them. In Texas, nearly one in four nonelderly adults is uninsured. A few large counties like Dallas support a robust safety net, while many smaller counties provide much less assistance. 

Access to health care that varies by county highlights just how far we still must go to achieve equitable health care coverage in the U.S. A few weeks ago, I rounded with our gynecologic oncology team. I heard stories of uninsured women presenting with late stage cancer – the disease progressing while they attempted to find a provider willing to take on their care. They did not have access to services in their counties of residence outside of Dallas, and found care eventually through the Parkland emergency department.

This “out-of-county care” creates competing tension as the local newspaper attempts to quantify the costs and citizens’ groups question why Parkland provides unreimbursed care to residents of counties that do not contribute to that care. Still, in the absence of comprehensive federal or state policies, the solutions often fall to local providers to make it a priority to create more equitable systems of care so people with treatable conditions do not unnecessarily suffer for lack of access in the shadows of some of the most advanced health care in the world.    

Fred Cerise served as the Vice President for Health Affairs at Louisiana State University and is currently the Chief Executive Officer at Parkland Health and Hospital System.

How do you trust a health system after you have seen its cracks?

Posted June 17, 2021

My mother had a stroke at home during the first month of the COVID-19 shutdown. My sister and I, both physicians with more than 20 years of health care experience, were blindsided both by her stroke and the health care system’s response, which allowed her to fall through the cracks.

Prior to having a stroke, my mother developed sudden left leg weakness and fell repeatedly, which was new for her. Normally, a patient with these symptoms would be evaluated in the emergency room with a physical exam and a brain MRI for evaluation. After calling her neurologist, however, she was told to monitor her symptoms at home. We were told that her symptoms were likely due to a progression of another chronic condition.

We knew there was broad concern about COVID-19 exposure and her doctors were hesitant to bring her into medical facilities, but we called repeatedly with concerns about her symptoms progressing and hopes to confirm a diagnosis. Without a proper diagnosis, and because my mother was still experiencing symptoms, we decided to bypass her initial physician to obtain an MRI. The MRI concluded that my mother had in fact suffered a stroke, which required medication changes, lab monitoring, and physical and speech therapy.

While my family struggled with her clinical decline for many months, our trust in her health care system was broken after communication broke down. She felt alone in navigating her care—especially after multiple delays. My sister and I—working within our own health systems that were desperately trying to make rapid changes during the shutdown—could understand a level of uncertainty by her care team and the health care system. However, we believed that the system would have safeguards for emergent care. We were shocked by the lack of communication or acknowledgment of the delays, and the lack of help to navigate a path forward. We also could not help wondering: What if she did not have an accent when she initially called for help? Would she have had more success if she was not an immigrant and was more familiar with the workings of our health care system? I am not sure of the answer to these questions. However, I do know that even with two physician daughters empowered by education and training, my mother’s trust in health care was easy to break and will be difficult to regrow.

Dr. Reshma Gupta MD, MSHPM is a practicing internist, Chief of Population Health and Accountable Care at UC Davis Health, and part of the Population Health Steering Board for strategy across all UC Health campuses. She serves as a senior advisor within the Center for Medicare and Medicaid Innovation Primary Care First Program and a Co-Director of Costs of Care Inc.   

How COVID-19 may be the catalyst we need to accelerate trust in medicine

Posted June 03, 2021

A couple months into the pandemic, as my clinic settled into the new normal, my nurse urgently summoned me to see a patient in our drive-through testing site. I ran out to the parking lot to find a Pakistani gentleman in the front passenger seat, his wife in the driver’s seat, and his four daughters packed in the back—all alert and scared. He was coughing and wheezing and had an oxygen saturation hovering between 89% and 91%. After examining him, I concluded that he should go to the emergency room. While he didn’t quite need oxygen yet—as someone in his late 60s with long-term exposures to air pollution—he might have needed it soon, and I preferred him to be closely monitored in a health care facility.

By bringing care to patients rather than making patients go to care, we saw them on their terms. We met them where they were – not just physically but often emotionally as well.

His daughters’ eyes widened at the suggestion. New immigrants to the country, they were mistrustful of the government and hospitals. They were also uninsured and scared about what it would mean for their family’s finances. He asked if there was another way.

After stepping aside to think about their situation, I instructed the family on how to support and monitor his condition at home. I gave them a pulse oximeter that they could use to monitor his oxygen levels. I also instructed them to go to the emergency room or call us immediately if the levels consistently dropped below 88%. And finally, I gave them my personal cell phone number and had them text me to make sure they had the right number.

The next day or two were touch-and-go. They messaged me a few times about his lack of energy and fatigue. I called them once when his oxygen level was briefly low. But, we ultimately decided to keep him at home. And after a couple of seemingly very long days, he turned the corner.

Today the family still comes to see me in clinic and never hesitates to bring me sweets or other small tokens of their appreciation.

COVID-19 changed health care for the better

COVID-19 magnified many longstanding failures of the health care system. Perhaps none of these were starker than the deep lack of trust in doctors, health systems, and public health in general that had already been increasing in the past several years.

At the same time, I’m optimistic. COVID-19 has also accelerated changes to health care that I believe create a catalyst to rectifying this longstanding failure. As I’ve written in my book, during the pandemic, health care became more distributed, digitally enabled, and decentralized.

By distributed care, I mean that care will increasingly happen where health happens: at home and in the community. During COVID-19, we saw virtual visits skyrocket and home visits increase. We provided testing and vaccination at drive-through sites, churches, and football stadiums. By bringing care to patients rather than making patients go to care, we saw them on their terms. We met them where they were – not just physically but often emotionally as well.

Care also became digitally enabled. We finally recognized that the real role of technology in health care should be to increase the care in health care. Outfitted for the first time with a clinic iPhone, and already calling my patients over FaceTime and WhatsApp for their virtual visits, I found myself messaging with my patients between visits. I texted them about whether they picked up their medications yet, and they would message me to let me know that they tried picking up the medication, but that it cost more than $100 and they couldn’t afford it. Often these exchanges would end with warm appreciation and emojis – of smiling faces or namastes.

Care also became more decentralized. We put more resources in the hands of frontline care teams and patients. My safety net clinic received grants to support proactively calling people who needed the vaccine or canvassing door-to-door. We also empowered patients with equipment like the pulse oximeter we gave Mr. Salim, and we taught patients more about self-care – like how I talked to his family about how to support him and when to escalate care to an emergency room.

COVID-19 changes may catalyze greater trust

The “three Ds” accelerated by COVID-19 (distributed, digitally enabled and decentralized) map well to the “four Cs” the ABIM Foundation has developed for enhancing trust.

Competence. Often what doctors do seem to be a mystery. You don’t know what’s in their head or why they’re doing things. The shift towards decentralization, where patients are given more resources to make their own decisions, will help. Rather than “Hey, you need to go to the emergency room,” we’ll tell patients that we recommend the ER because their oxygen is low and medical guidelines say that oxygen below certain levels are dangerous. For my patient, this led to an acknowledgment that his oxygen level was on the border and that based on his preferences, there was an alternative option his family. This may be no more or less competent from my perspective, but from his family’s perspective, it became clear. I imagine that if his oxygen level did dip below 88% after a day or two, he would have a lot more trust that he truly did need to go to the emergency room, whatever the ramifications might be for his family.

Caring. Often the best way to be caring is to have empathy – to see and understand people as a whole person, and not just a patient in a gown. Virtual care and particularly video visits offer doctors a window into the home. Seeing patients in their own environment helps me understand who they are. Seeing the Pakistani gentleman with his wife and four daughters – something that is often hard for families to do in a clinic-based environment due to logistical and financial barriers – allowed me to tap into my own empathy in order to treat him. He was no longer a COVID-19 patient with respiratory symptoms. He was a father and a provider to the five women in the car with him.

Communication. Communication in health care is often very formal. There is a visit followed by weeks or months of silence before the next visit, and so on. This is not how we communicate with the people we care about. We send emails and texts and have phone and video calls. Digital communication can sustain and strengthen relationships that were originally built in-person. Knowing that he and his family could each contact me – that I was just a text away – was critical to their having enough trust to take care of their father at home.

Comfort. Care that happens increasingly at home and in the community is care that happens on patients’ own turf – sometimes literally. In an era when many lack access to medical facilities or are too mistrustful to step foot in one, the fact that care can start in their own environment can be a great source of comfort, particularly as relationships are still being built.

Many of the changes I described may reverse after the pandemic; the changes so far have been important, but small. COVID-19 is simply a possible catalyst. It is up to us to seize this opportunity to rebuild trust with our communities and our patients.