What we all know now about Flint is that long before the politicians acknowledged that they had switched the water sources from Lake Michigan to the corrosive and poison-laden Flint River, families were complaining about what they perceived to be unsafe water. Families described hair loss, diarrhea, rashes, and headaches. And while much praise is due to the pediatrician and her team who rigorously collected the data on lead poisoning and advocated for her patients, there had to have been times when families complained of the water to their health care providers, who assured them it was fine.
I know this because it is what I do.
In our primary care center at Yale, I serve patients living in racial and economic segregation, much like the Flint population. For years before, and even since, the Flint news broke, I have told my patients that the water supply in New Haven is as good as the water supply in surrounding towns, and that they should use the tap water because it is safe, has fluoride in it for healthy growing teeth, and is less expensive than bottled water, and because it is better for the environment to avoid plastic water bottles.
I don’t yet know what the repercussions from Flint will be on building rapport with my patients, but it’s hard to believe that the distrust won’t ripple all the way to New Haven. It’s hard enough as it is.
It makes sense that trusting relationships between families and their health care provider are associated with better child health — families are more likely to call their doctor when they are worried and seek care, and then follow directions,if they have a good rapport with that doctor. But trusting relationships occur less commonly among households with no health insurance, lower income, and minority ethnic status. And when a patient and health care provider are different — in race or primary language — there are fewer trusting relationships and less appropriate use of health services.
In places like our primary care center, patients largely come from neighborhoods of racial and economic segregation — and the doctors do not. This means that building a trusting relationship — even before Flint — has been a challenge that we’ve worked to surmount through improving our communication skills, practicing patient-centered care, and conducting group well-child care. In group well-child care, pediatricians and four to eight families with children the same age come together for the typical aspects of a check-up — physical exams and vaccines — as well as to focus on parental self-efficacy, trust-building, and communication.
But Flint has added an extra huge step in the ladder to functioning, trusting relationships.
In a group well-child care appointment last week for nine-month-old babies, doctors in my clinic were discussing with parents the importance of adding water to their child’s diet. Nine-month-olds can start drinking water from a cup. Water is healthy, it’s inexpensive, it flows from the tap, and you never run out of it, my colleagues said.
One mother asked if the New Haven water supply was better than Flint’s. My colleague answered that the water in New Haven was fine. And it probably is. But as she sat there and discussed with parents all the other important guidance we share with families in order to help children grow up healthy — safety and language development and flu shots — she wondered about the validity of her statement about the water supply. And whether she would lose her patients’ trust as the story of Flint continues to unravel.Dr. Marjorie S. Rosenthal is assistant director of the Robert Wood Johnson Foundation Clinical Scholars Program and associate research scientist in the Department of Pediatrics at Yale University School of Medicine.