Tips for Clinicians: Establishing Rapport and Trust

“By investing yourself in creating the trust of one Hmong person, you will build the trust of many. The loss of trust of one will lose the trust of many.”
—Gervais, 1996, p. 50

The above quotation reflects the systemic implications for the establishment of trust.

Respect and Dignity

As a first step, members of the Hmong community (particularly elders) must be treated with respect and dignity. A sincere, open-minded, non-judgmental attitude is imperative in the effort to establish a trusting relationship. Also, listening to patients’ beliefs, desires for treatment, and reactions to recommended biomedical treatments can form a basis from which a trusting relationship can develop. Traditional beliefs should be accommodated whenever possible, whether as an adjunct to or as an alternative to Western medicine.

Preconceived Notions

Furthermore, it is important to view “trust through the lens of those whose trust we seek” (Kumanyika, 2005, p.84). Establishing a trusting relationship with Hmong elders is often challenging due to preconceived notions either created through personal experiences or those experienced and shared by others. Therefore, the issue of trust is very complicated. As an insider within the Hmong American community, the second author, Lhee Vang, MA provides insight into some of the perceptions that promote mistrust toward Western Medicine.

Distrust of Western Medicine

Too often, Western medicine is perceived as an experimental system. This view is reinforced by the evolving foundation of medical knowledge (i.e., clinical trials) to guide practice. Elders have also heard stories of teaching hospitals where medical students “learn and practice” on the patients who are entrusted in their care. Equally as alarming are the stories of cadavers being used to teach anatomy to medical students.

In addition, stories about unsuccessful medical treatments are repeated to members of the Hmong American community to serve as cautionary tales. Over time these tales become part of the Hmong lore regarding Western Medicine. Consequently some Hmong Americans are fearful that medical treatment in and of itself may cause the person to become sicker than they were prior to treatment. This preconceived notion may prevent some elders from taking prescribed medications.

In general, Hmong people believe that accountability must be shared by all. Hmong American elders have expressed concern regarding the “lack of guarantee” associated with treatment outcomes in Western medicine. This is generally viewed as a lack of accountability. Elders are often fearful that clinicians will do whatever is convenient without genuinely caring about the patient’s welfare. Consequently, this strengthens the elders’ need to have family present to aid in the decision making process. Therefore, accountability is shared within the family.

Traditional Healers vs. Western Health Practicioners

It is also important to explore the various perceptions held by elder Hmong Americans of traditional healers compared to Western health care practitioners. Often, traditional healers are viewed as integral members of the Hmong American community whose skills are highly respected. Traditional healers generally have a socioeconomic status that is equivalent to their patients. In contrast, physicians are often viewed as being at a higher socioeconomic status, whose primary motivation for their chosen profession is monetary profit. In addition, physicians are often viewed as taking a mechanistic approach to health care compared to the holistic approach of the traditional healer.

Many Hmong elders believe that, within the Western medical health care system, mainstream American patients, particularly those of a high socioeconomic status, receive better care and treatment (i.e. medications) than themselves, of lower status. Elders often perceive an imbalance in power between themselves and the Western health care providers.

As a result, they may feel the need to be obsequious to clinicians or the need to continue to seek opinions from multiple providers in an effort to receive better care and medications. The pretense of being subservient to clinicians and the option of making their own determinations at home, without communicating those decisions to providers, may be the elders’ routes to asserting their own power.