The patient-provider relationship in healthcare has evolved far from its initial paternalistic model. A “provider” refers to a medical professional who determines the course of care, but comes secondary to the “patient” in terms of patient needs and autonomy, as implied within the placement of the two parties in the word itself. Reliant on trust between the two parties, this fiduciary relationship can be strengthened through meaningful connections and has been shown to boost positive health outcomes. [1] In rural healthcare environments, these relationships are observed to be far stronger in contrast to its urban neighbors. It is critical to characterize these strong patient-provider relationships as a cornerstone in rural healthcare that can provide insight into unique methods of bridging gaps in rural healthcare equity.
Assessing Providers as Community Figures
In smaller communities, healthcare providers assume the role of influential community figures, entrusted with community well-being beyond just medical treatment; they encompass the cultivation of interpersonal connections. The profound impact of such connections on healthcare experiences is illustrated by personal accounts; Ebony Talley-Brame’s narrative exemplifies the impact of personal connections in rural healthcare. Despite the formidable challenges posed by limited resources, Ebony found solace in the compassionate care delivered by her neighborhood dentist, Dr. Henderson.
“He was such a great man, and, to me, he just took care of you and was very compassionate about what he did. I’ve gone to him for dental care since I was a child and even now, returning home, I still go to him.” [2]
Her story serves as a powerful testament to the transformative influence of personal connections in rural healthcare, transcending the constraints of distance and resources. Ebony’s experience underscores the significance of genuine human connections in fostering trust and a sense of belonging among patients. In rural settings, where populations often skew older and more religious compared to urban centers [3], the establishment of trust is further complicated. Megan Reilley highlights this challenge in “Health Disparities and Access to Healthcare in Rural vs. Urban Areas,” emphasizing the connectivity of competent care with mutual sense of trust of patient and provider. Reilley notes that without acceptability of patients’ values, there’s a risk of stigma and deepening mistrust among individuals, emphasizing the necessary role of providers in fostering an environment of trust and acceptability in rural healthcare settings. She encapsulates the relationship by a perfect “fit between the provider’s attitudes and beliefs and the patient’s attitudes and beliefs.” [4] The responsibility falls on healthcare providers to bridge the gap, fostering trust and acceptability through strong patient-provider relations, thereby ensuring equitable access to quality care in rural communities.
Provider Attitudes Influencing Patient Perspectives and Outcomes
The provider and the patient are not independent of each other, but rather both rely on each other and can have profound impacts upon each other – more so, how providers influence patients. But there is a stark dissonance in modern, urban spheres of healthcare with this notion. Barbara Brayboy vividly recounts the blatant contrast between her childhood experiences of healthcare interactions and the impersonal nature of contemporary appointments. She reminisces about a time when doctors engaged with patients on a personal level, discussing ailments and treatment options with care and empathy. However, as she reflects on modern healthcare encounters, Barbara laments the depersonalization she perceives, with doctors lacking in meaningful connections with patients.
“Growing up, when my mom went to the doctor, the doctor would sit and talk to her… I find now that even when I go for my regular checkup, they come in with their computer. They don’t look at you.” [5]
Her observations underscore the erosion of personal connections in modern healthcare, a phenomenon particularly pronounced in rural settings where such bonds hold immense significance. Barbara’s narrative serves as a poignant reminder of the importance of these connections. It highlights the significant impact of provider attitudes on patients themselves, shaping their satisfaction with care and also subtly influencing patient perspectives. This dynamic relationship between provider attitude and patient experience is further exemplified in a study comparing urban and rural healthcare providers’ perspectives on HPV vaccination in Minnesota. The study emphasized that a trusting patient-provider relationship is crucial to increasing vaccine acceptance, with rural providers often fostering more multifaceted bonds with patients, rooted in trust and mutual understanding, while urban providers relied more on professional expertise and factual information. [6] The juxtaposition between the more intimate, trust-driven care of rural settings and the increasingly depersonalized nature of modern healthcare illustrates the critical importance of genuine human connections in better health outcomes for rural patients.
Patient-Provider Relations and the Possibility of the Change
Assessing the unique rural patient-provider relationship offers a valuable lens through which to develop innovative solutions for addressing rural healthcare challenges and improving overall patient care in the future. Within the context of telehealth implementation in rural populations, a promising solution to bridge gaps in healthcare access, understanding the intricacies of patient-provider dynamics is crucial. This understanding is reflected in the utilization of frameworks such as Pender’s Health Promotion Model (HPM) and Appreciative Inquiry (AI) to survey telehealth applications in rural environments particularly in Appalachian Ohio in post-COVID times. [7] The study found significant knowledge gaps and barriers to telehealth adoption, including concerns about the impersonal nature of virtual visits and infrastructure limitations such as broadband internet access – in contrast to the comfort of their strong connections with their local physician during appointments. Despite these challenges, there is a clear desire among rural residents for increased healthcare access through telehealth, but a lack of foundational knowledge persists. Interestingly, it was noted that rural patients were more willing to implement telehealth solutions based on provider perspectives, again showcasing the importance of trust in rural patient-provider relations. Still, addressing broader infrastructure disparities remains essential for the widespread implementation of telehealth in rural areas. By leveraging insights from the rural patient-provider relationship, future efforts can focus on developing sustainable solutions that enhance healthcare access and improve patient outcomes in rural communities.
Conclusion
In essence, rural healthcare thrives on the strength of patient-provider relationships, rooted in trust and personal connection. Despite challenges, such as limited resources and technological barriers, the bonds forged between healthcare providers and their rural patients remain resilient. As we navigate the future of healthcare delivery, it’s essential to recognize and celebrate the unique character of rural healthcare, where genuine human connections lay the foundation for improved patient outcomes and community well-being.
References
[1] Drossman et al. “Improving Patient-Provider Relationships to Improve Health Care.” Clinical Gastroenterology and Hepatology, 13 Dec. 2019, https://www.sciencedirect.com/science/article/abs/pii/S1542356519314326 [2] Talley-Brame, Ebony. “Y-0054.” Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill, 22 June 2018. [3] Murray, Billie, and Susan McCrone. “An Integrative Review of Promoting Trust in the Patient-Primary Care Provider Relationship.” Journal of Advanced Nursing, vol. 71, no. 1, Aug. 2014, pp. 3–23, https://doi.org/10.1111/jan.12502. [4] Reilly, Megan. “Health Disparities and Access to Healthcare in Rural vs. Urban Areas.” Theory in Action, vol. 14, no. 2, Apr. 2021, pp. 6–27, https://doi.org/10.3798/tia.1937-0237.2109. [5] Brayboy, Barbara. “Y-0011.” Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill, 11 July 2018 [6] Polter, Elizabeth J., et al. “Urban and Rural Healthcare Providers’ Perspectives on HPV Vaccination in Minnesota.” Human Vaccines & Immunotherapeutics, vol. 19, no. 3, Taylor & Francis, Dec. 2023, https://doi.org/10.1080/21645515.2023.2291859. Accessed 28 Mar. 2024. [7] Bowen, Annie, . “Assessing Readiness for Telehealth in Rural Communities”. Journal of ChristianNursing, vol. 39, no. 4, Oct. 2022, pp. 221-227. doi: 10.1097/CNJ.0000000000000888.