Health Care Turnover Cuts Trust and Erodes Patient Care

Source: -MayaQ-/Pixabay

A while ago, I wrote about grieving the loss of physicians who suddenly vanish. Since then, health care practitioners have continued to leave or change their practices, leaving me and other clients rudderless, forced to educate new practitioners on our conditions.

I can’t blame them for burning out or seeking new challenges. But it's not easy to bring a new practitioner up to speed when you have a long, complicated medical, dental, social, economic, and cognitive history after brain injury. Educating and learning a new person's facial expressions and body language suck you dry. Losing trusted support over and over leads to separation anxiety and diminished capacity to trust.

It sets me back.

Long before my brain injury, I talked with a friend with paralysis who needed daily help. I had visions from TV shows of a trusted person who cheerfully and competently supplied the physical aid my friend required. A person who stayed in their life and gave them a bedrock to rely on as they went out to work or lived life like the rest of us.

I was wrong.

Every two years, my friend’s support worker would leave, requiring them to interview for a new one. Sometimes, the new worker would end up being more like a slippery mud bank than a granite foundation, which they had to endure for two years.

I was appalled.

Imagine having to put your trust in a new person every two years for your most intimate daily physical needs, nourishment, and bedtime routines? Imagine spending the energy and time required—robbed from your work and leisure time—to find a new person and then hope you chose well? I couldn’t.

For two weeks after my car crash, I experienced the heaven and relief of a competent, cheerful personal support worker, paid for by my auto insurance. Subsequently, they became stingy in funding home care, while the home care companies sent workers who treated my brain injury as permission to take advantage of me. I received too few hours per week with cleaning and food prep help. The support workers were always cheerful, and always doing less and less as the weeks went along, until I fought through my brain-injury-inflicted communication barrier and objected. That never went well. Sometimes they’d send a new worker. Sometimes they’d fire me, for companies will tell you one thing about their quality of service standards, but will treat you as a behavioural problem if you insist their standards be met. I experienced turnover like my friend. I had to teach and, within my brain-injury limitations, develop a new relationship.

It brought home to me how much of a difference competence, long-term stability, and trust in any health care worker—from physicians to dentists to therapists to personal support workers—make to recovery.

I switched from home care to cleaning services that cater to the busy healthy. These companies actually mean it when they set standards for their workers. They accommodate their clients. Their workers also stick around longer. That builds rapport and trust. Isn’t it ironic that I have a better chance of developing a relationship with workers from a cleaning company than I do with personal support workers from a home care service?

Researchers have studied the key elements to making a good recovery from injury or illness, revealing that relationship is the most important element.

Adrienne Sabety wrote in a 2023 paper, “I provide evidence that patient-PCP [primary care physician] relationships are valued by patients and are good for patients’ health. In response to an exogenous loss of a longstanding PCP, adverse events increase: patient mortality increases by 4%, emergency department visits increase by 4%, and hospital admissions increase by 3%.”

Sabety observed something my father experienced as well: “Patients with the longest tercile of relationships are 14 percentage points more likely than patients with the shortest tercile of relationships to follow their moving PCP….patients value having a relationship with their PCP and this value increases over the length of the relationship.”

My father, a retired gastroenterologist, was renowned worldwide for his care of patients with Crohn’s disease and ulcerative colitis. Patients came from other provinces to see him; I even met one who moved from the USA to Canada so that my dad could be his doctor. (I met many of my father’s patients socially because they considered us family, as I related in my book Lifeliner.) During his sabbatical, some of his patients told me that they wouldn’t see anyone else until he returned because they didn’t trust the other doctors. I knew their decision could jeopardize their health, perhaps their life. They knew it, too. Yet they believed they had a better chance at living by sticking it out for a year than seeing another doctor in the interim.

No matter the profession, the longer the relationship, the more advantageous to the client’s health and the more adverse the effect when they leave.

I heard another story.

This one was about a person who needed home health care from multiple professionals. They were entirely reliant on these professionals to look after their daily needs and had been chronically ill long enough to know that every couple of years, their carers would change. This person stopped calling them by name. They called them by title. When one objected and repeated their name, they said, “Who gives a shit what your name is?! You’re going to be gone, anyway, like the others.”

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I’m not as bellicose, but I don’t feel like it’s worth bringing new practitioners up to speed anymore. It’s dispiriting and cognitively exhausting relating, once again, my medical history; they don’t listen long enough, anyway. Whatever they read in my charts—if they read them, which is not a given, as I’ve discovered—is enough. As I noted with learned helplessness, I already feel it’s useless to share my thoughts beyond what they need to do their job.

Why build rapport and a relationship when they’ll go like the others?

Copyright ©2025 Shireen Anne Jeejeebhoy