April 29, 2025
3 min read
Key takeaways:
- Greater distrust in the health care system was associated with lower likelihood of kidney transplant wait-listing for some patient groups.
- Individual physicians can help earn patient trust.
Patients with kidney disease may have their own reasons for not putting their faith in the health care system, but physicians can help earn their trust with small behaviors, according to an expert.
Healio talked with Justin Ponder, chief learning officer at the leadership development training company Uplifting Impact, about how mistrust might affect patient care in nephrology and how kidney care specialists might counter that mistrust. Ponder gave a plenary presentation at the Renal Physicians Association Annual Meeting in Las Vegas in April.
After the presentation, Ponder said health care professionals can “do small things in our communication — micro-behaviors, micro-communication things — to earn more patient trust.”
“Even if we’re the nicest, friendliest, coolest person … there are still a whole lot of other people before us who may have caused our patients … to have all kinds of mistrust,” Ponder told Healio. “So, what can we do to continually earn that trust and to re-earn it time and time again? Slowing down and taking time to figure out different communication styles … taking time to read the situation, to adapt, to modify and really connect with people.”
Distrust in nephrology
Nephrology is not exempt from patient mistrust. And at least anecdotally, mistrust can affect kidney care.
In his presentation, Ponder related the divergent experiences with kidney care of his grandmother and father, both of whom were diagnosed with polycystic kidney disease at about the same age.
“When she began to go through the years of treatments … she trusted the doctors, she trusted the process,” Ponder told the audience about his grandmother. “But somewhere along the line, that respect was not reciprocated. … All I know is that she was on dialysis for many years and that she was going for a regular checkup with her kidney doctor, and he said something. … Whatever it was, it was something condescending, dismissive enough that at that moment, she decided she was no longer going to do dialysis.”
Ponder contrasted his father’s experience with his health care team.
“Something was different,” Ponder said. “He was just as religious as she was, just as many terrible jokes as she had, but his kidney care providers had something different. They spent more time with him, they tolerated his jokes, they acknowledged how important his faith was to him, and he continued on with the process. … His life was saved because a doctor spent more time with him, established more trust and listened to him just that a little bit more.”
Some recent studies affirm the connection between trust in health care professionals and use of medical care by adults with or at risk for kidney disease.
In a study published in BMC Nephrology in 2019, researchers found Black adults at high-risk for chronic kidney disease who expressed low trust in medical care were more than twice as likely as those with high trust to have no routine health care in the previous year.
A study published in JAMA Network Open in 2022 connected racial disparities in kidney care with racism and distrust in the health system. Black veterans with CKD expressed distrust and hypervigilance — a symptom of high stress — when interacting with physicians.
“[Participants] described feeling like they always had to prove themselves to medical staff and clinicians. They would arrive at their appointments worried about appearing presentable and perfect; even then, they described feeling judged and ignored. Participants described a strong sense of distrust in the medical establishment and the health care system,” the researchers wrote.
A prospective study with kidney transplant candidates, published in Clinical Transplantation in 2024, linked distrust with likelihood of transplant wait-listing. Researchers found women and Black and Hispanic adults were more likely to express distrust in the values and competence of the health care system. Greater distrust was associated with lower likelihood of wait-listing for these groups.
“Implementing tailored strategies to reduce distrust in transplant care may improve kidney transplant access for groups that experience persistent disparities,” the researchers wrote.
‘Small things’ can earn more trust
Ponder described some small behaviors physicians can adopt immediately to help earn trust — making small talk; maintaining eye contact; using and laughing at attempts at humor; mirroring a patient’s body language, tone and vocabulary; asking clarifying questions.
He suggests physicians “micro-script out” sentences that incorporate these behaviors to use in patient encounters where “you show you acknowledge their effort to try and take control of their own medical situation without them feeling dismissed or interrupted.”
Taking time to show respect, Ponder said, “costs us nothing and has an enormous impact.”
References:
Diamantidis CJ, et al. BMC Nephrol. 2019;doi:10.1186/s12882-018-1190-0.
Jenkins KA, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.11900.
Ponder J. Understanding culture for better patient care. Presented at: Renal Physicians Association Annual Meeting; April 3-6, 2025; Las Vegas.
Thompson VL, et al. Clin Transplant. 2024;doi:10.1111/ctr.15395.
For more information:
Justin Ponder can be reached at jp@upliftingimpact.com. Follow him on LinkedIn at https://www.linkedin.com/company/upliftingimpact/ and https://www.linkedin.com/in/justin-ponder-1200b72b/ and https://www.linkedin.com/in/deannasingh/.
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