The importance of a client’s first impression of your practice
Talking about aims for the therapy, and how these might be achieved, whatever friendly and welcoming atmosphere As with any relationship, first impressions can one's manner, and even one's attire, can be important in developing trust. An important factor for engaging the child client in relationship building is and Barrows () suggests making the initial contact through play therapy. . According to the social work participants, the trusting helping relationship is present .. Rapport is the initial assessment of a person based on first impressions, on. Relationships characterized by trust and rapport not only contribute to .. First impressions matter and continuity of care is important to patients him I needed mental help, he walked [me] straight to the counselor's office.
In this version, the two players had to decide separately and privately whether they were going to cooperate with each other or defect against their partner in exchange for a monetary reward.
Participants who experienced the immediate breaches of trust had the most negative evaluations of their partners. Even after 20 rounds of cooperation following the breach of trust, an immediate breach still generated more negative evaluations than did no breaches or late breaches. The payoffs for cooperating were designed to increase cooperation, he said. To encourage the participants to take the task seriously, the experimenter announced that several participants would be randomly chosen to receive some of the actual money they won in the game.
In the first experiment, students played multiple rounds of the game on a computer that they were told was networked to a student in another room. But they were actually playing with a computer that was programmed to defect at specific points during the more than 30 rounds of the game. Some participants were paired with a computer that defected against them immediately, in the first two rounds of the game, while others defected in rounds 6 and 7 or rounds 11 and In all cases, the computer was programmed to cooperate for 30 rounds following the defection, regardless of what the participant did.
Another group of students were paired with computers that were programmed to always cooperate with the participants throughout the experiment. Participants were notified on their computer when there were only 10 rounds left in the game. They cooperated less than 70 percent of the final 10 rounds, suggesting they had the least trust in their partners. Participants who experienced a trust breach latest in the game — after 10 rounds of cooperation — showed the most cooperation at the end of the game, cooperating more than 90 percent of the time.
That was actually slightly higher than participants whose computer partner never defected during the game. They need to hear that they are on the right track and that they are doing okay on treatment. Bill, a flight attendant in his mids who was diagnosed with HIV over a decade ago says during his first interview: Sometimes you just want to go in and get the results of your last labs and go. Other times you need to be reassured. The consequences of not receiving the desired reassurance from the provider can be psychologically devastating.
Alex, a man in his mids, attempted suicide the day after he was diagnosed with HIV at a non-VA facility.
During his first interview, Alex reflects on his recent diagnosis, and how he found out: The mindset of having to go and tell my family that I was HIV positive, it was just overwhelming ….
He just brushed me off. Such a conversation would have helped the patient clearly understand what to expect, which in turn, would have likely lessened his desperation. Other patients worry that asking questions may offend their doctors. They worry doctors will feel that their expertise is being challenged. When they do ask questions, and the experience is favorable, patients feel relieved and highly appreciative. Peter, who underwent a lumbar puncture, felt great relief when the doctor addressed his concerns in a receptive manner.
He describes his interaction with the provider during his third interview: I just asked her. How much experience do you have doing this? Even the residents that came in were easy to talk to and easy to ask questions.
Even though the doctor provided only a minimal response by saying she had performed the procedure at least oncethe patient was accepting, and moreover happy that he had not offended the doctor.
Tom, who rated his doctor a 10 out of 10, gave an example of how his doctor made him feel comfortable asking questions. During his second interview, he says: Repeated invitations to ask questions allowed the patient to get answers for all the issues of concern, as well as to ask some that he would not have otherwise felt comfortable asking. They want to see their actual test results on the computer screen or print out, and be told if the numbers look better or worse.
David, a former occupational health technician in his mids, explains the importance of knowing these details: They have a habit of forgetting, you know, you do seventeen vials of blood. They- I want to know what those seventeen vial- vials of blood are going for.
Jane, a retired graphics artist in her earlys, compared a provider who went over her labs to one who did not.
She said during her first interview: She was so nice. I think they [doctors] should automatically discuss…. Explain to me what these numbers are. Actually I have a very high IQ…. Turn the screen around or hand me a printout or something. Patients, especially those with HIV, derive meaning from learning the specifics of their lab work, which indicate how they are doing in their overall health and tell them what they need to change to live a long and healthy life.
When doctors respond kindly and without judgment, patients take particular note. John, a computer engineer in his lates, says during his second interview: There was no uh- uh you know off color remarks… nothing like that. Chris, a retired pharmacy technician in his mids, worried that his doctor would scold him about his weight and eating habits.
He describes in his second interview how his doctor reacted to his high cholesterol: And she told me about my cholesterol being high. She says well it's Patients want above all a supportive doctor, one who does not point out shortcomings that they already are aware of. Rather, they want a doctor who will make a genuine effort to understand them. However, they still want the doctor to lay out their options and ask for their input. Tim, a man in his earlys who was just diagnosed with HIV, says in his first interview: And then try to work with me in that regard.
In his second interview, Ken the retired electrical lineman, talked about a positive experience with a doctor who explained the rationale for his recommendations and made sure Ken agreed with them: Patients want a two way dialogue with their provider, an interactive exchange where patients are asked about their treatment goals and preferences. They want to feel like they have a say, and that the doctor is willing to work with them in achieving those goals.
In essence, patients want their doctors to involve them in decisions about their care. Discussion This qualitative study provides a strong understanding of what patients value in their health care providers. Our analyses show that patients experience significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider.
Our study is unique in identifying five actionable behaviors that have the potential to greatly improve the patient care experience: Patients cited these items as effective in mitigating their anxiety and building a trusting, long-term relationship with the provider. Patients entering a new relationship with a provider can experience heightened psychological distress, ranging from feelings of vulnerability as a new patient, to fears, situational anxiety and panic, especially when the condition is life-altering.
Moreover, emotional needs may differ markedly between new patients recently diagnosed with a life-altering illness versus those who have experienced the illness for some time, and those who encounter greater illness intrusiveness [ 21 ]. A key step in building a therapeutic relationship is to recognize that some patients may have greater emotional needs, and that one approach may not fit all [ 2223 ].
Our qualitative findings show that many patients want to play an active role in their own medical care.
They want to engage in a two-way dialogue with their provider, clarify expectations, voice their concerns and ask questions. They are reluctant to ask questions for fear of being perceived as a difficult patient [ 24 ]. Even highly educated patients and patients with a medical background worry about the consequences of asking questions. Strikingly, even patients with a serious medical condition like HIV infection, where the stakes are far greater, worry about offending their doctor.
In the absence of the doctor explicitly reassuring them that it really is okay to ask questions, many patients remain silent. To facilitate open communication, patients want doctors to give them explicit permission and encouragement to ask questions. Our data suggest that although patients certainly value affective reassurance e. In our study, these actions not only reassured patients, they also empowered and encouraged them to become more proactive in managing their condition. Patients with stigmatizing conditions such as HIV infection, mental illness, substance abuse and obesity, worry about their providers judging them.
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Our data show how providers, even with good intentions, may inadvertently ask patients questions that elicit feelings of blame, shame and anxiety e. Research indicates that stigma in the health care setting is still quite prevalent, and can lead providers to spend less time with the patient, have lower expectations of their adherence, and make fewer referrals for preventive and specialty care [ 32 — 38 ]. Despite the clear benefits of patient-centered care, time pressure and lack of training in communication skills are structural challenges facing providers.
Physicians have to balance spending enough time with each patient and staying on schedule. To achieve this balance, physicians may feel forced to interrupt patients and minimize open-ended questions. A more recent study confirmed these results [ 42 ].
Other communication skills such as conveying empathy and providing reassurance do not necessarily extend the visit length but can greatly enhance the quality of the patient-provider relationship [ 4849 ]. Our study points to strategies health care organizations can implement with minimal costs or changes to clinic flow.
First Impressions Are Important for Trusting Relationship
Given the importance of the first impression for building trust and rapport early on, care organizations can strategically schedule new patients at times of the day when providers may feel less time pressured. Moreover, given the importance of continuity of care as a significant driver of a positive patient experience, care organizations can make an extra effort to make sure that patients follow up with the same provider.
Our study points to explicit steps and language medical educators can use to teach trainees and experienced physicians, so that patients feel supported and encouraged to talk openly and honestly about their concerns and worries.
Medical trainees are particularly likely to benefit from such training, as they are still developing their communication skills and have yet to establish set behaviors [ 50 ]. Experienced physicians can also learn new communication techniques, especially ones that are concrete and easy to incorporate in their clinical routine [ 51 ].
To effectively teach these skills, educators must move beyond oral presentations and written handouts, and incorporate external input, such as timely, individualized feedback based on direct observations of patient-provider encounters [ 52 — 55 ]. The actionable steps derived from our research could serve as a framework for such feedback.
Our study has several methodological strengths. To our knowledge, this is the first qualitative study to examine what patients new to an HIV clinic expect and value in their providers. The longitudinal nature of our study allowed us to examine recurring themes that emerged over the course of six to twelve months of subsequent care. Almost half of the participants in the study were Black or Hispanic, populations underrepresented in studies on the patient care experience.
Our study has certain limitations. We conducted our study among mostly male patients with chronic HIV infection at one public institution, and our findings may not generalize to other patient and disease populations. However, our findings add to the literature on patient experience, and we believe they are especially useful to providers who care for patients with stigmatizing chronic conditions such as mental illness, substance abuse and obesity.
Acknowledgments We thank Drs. Street, Jr, Lindsey A. Martin and Kristin K. Kostick for their critical review of an earlier draft of this manuscript. Availability of data and materials This is a qualitative study with full length interviews. BND drafted the manuscript.
First Impressions Are Important for Trusting Relationship
All authors critically reviewed the manuscript and approved the final version. Competing interests The authors declare that they have no competing interests. Consent for publication Not applicable.
Disclaimer The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Contributor Information Bich N. Fitzpatrick R, Hopkins A. Problems in the conceptual framework of patient satisfaction research: Frankel RM, Stein T.
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“First Impressions are Everything!” | SiOWfa Science in Our World: Certainty and Controversy
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