Before the incision: How thyroid surgeons foster patient trust preoperatively

Patient trust in physicians is crucial but has declined over time. Understanding what language surgeons use to build trust may guide educational strategies to better prepare surgical trainees. This study aimed to identify trust-building language used by surgery attendings during preoperative counseling for thyroidectomy.

This qualitative study was conducted with patients referred for thyroidectomy, their surgeons, and trainees. Preoperative clinic visits were audio-recorded and transcribed verbatim. An inductive thematic analysis was performed, focused on trust-building language.

Across 3 academic centers, transcripts from 44 patients seen by 14 surgeons (6 otolaryngologists and 8 endocrine surgeons) and 14 surgical trainees (5 medical students, 7 surgical residents, and 2 fellows) were analyzed. Six types of trust-building approaches were identified. To build trust, attendings: (1) practiced bidirectional and closed-loop communication, (2) built a personal connection with patients, (3) demonstrated expertise, (4) acknowledged the uncertainty inherent to workup and/or management, (5) respected patient agency in decision-making, and (6) streamlined the care process. Surgical trainees modeled their attending's trust-building language, tending to rely predominantly on bidirectional/closed-loop communication skills and developing a personal connection with patients.

These results demonstrate several discrete trust-building approaches that attending surgeons used to build trust when counseling patients and inform a model for teaching trust building to trainees. While trainees already model some of these approaches, more advanced skills were not observed, identifying specific trust-building approaches as a focus for formal training.