Takeaway
Trust is built by showing patients their voice matters, especially when they disagree with us.
Connecting with patients | May 7, 2026 | 2 min read
By Debra Eluobaju MD, MPH, Johns Hopkins Medicine
She’d been to three different hospitals. Each time, she was told the same thing: “You need a repeat c-section.” With gestational hypertension and two prior cesareans, the recommendation was clear. But each time, she left unconvinced. By the time she arrived to my team at term, she was guarded. She listened carefully, but there was an understandable hesitancy shaped by prior encounters.
We reviewed her history. We explained our concerns. We made space for her priorities. She wanted to attempt a vaginal delivery. She spoke—we listened. In line with what she’d been told before, we recommended a cesarean. But we also offered a path forward: a carefully monitored induction of labor, with clear expectations, and ongoing reassessment. She agreed.
The induction was long and dilation stalled. When I returned to her room to discuss next steps, I prepared for resistance. Instead, she was crying and told me she felt like a failure.
I sat down beside her and told her she hadn’t failed. That she’d advocated for herself and made a thoughtful decision based on her priorities. That wasn’t a mistake, it was part of her care and overall journey. She nodded. “Ok,” she said. “I trust you.”
In clinical care, we often focus on delivering the “right” recommendation. We gather data, assess risk, and present a plan grounded in evidence and experience. But patients aren’t just processing clinical information. They’re also bringing their past experiences and personal values. When patients feel unheard or dismissed, they may decline recommendations even when appropriate.
Changing our approach
In this encounter, the clinical recommendation didn’t change. Our approach did. We listened. We asked about her goals and validated her concerns. We allowed space for a trial of labor within safe boundaries. In doing so, we shifted the dynamic from opposition to partnership.
It can feel inefficient to revisit recommendations that seem clinically straightforward. When risks are clear, it’s tempting to focus on persuasion rather than exploration. But prioritizing agreement without first building trust can have the opposite effect. Patients may disengage, seek care elsewhere, remain unconvinced, or feel coerced. Listening and acknowledging their concerns can build mutual understanding. And listening requires time, humility, and recognizing that patients may need space to arrive at their own decision.
How to build trust with patients:
1. Start with the patient’s perspective. Explore their understanding and values before offering recommendations.
3. Be clear and transparent about your concerns.
4. Be flexible. When safe, facilitate plans that allow for reassessment rather than immediate closure.
5. Remember that patients don’t have to agree with us.
6. Revisit the conversation. Trust is built over time, not in a single discussion.
Trust comes before consent. When patients feel heard, respected, and valued, they’re more willing to reconsider recommendations and to partner with us in their care.
The goal isn’t simply to reach the right decision. It’s to reach it together.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.