Trust

Trust underpins the way doctors and patients interact, and trainees are always encouraged to build a rapport with patients, put patients at their ease and effectively gain their trust to enable a fruitful doctor-patient relationship to flourish.

In the background though are often competing demands on the emotions of doctor and patient alike.  A couple of vignettes might explain a bit better;

A patient I met recently found herself without a vital lifelong treatment because she was ‘treated like a child’ and then ‘dismissed’ when she attended a clinic and was refused a prescription because she wasn’t following the rigid protocol, and no flexibility was allowed.  She said this was because some ‘idiots don’t know how to look after themselves’ and she was refused despite being a long-term patient who usually managed her own medication very well.

The other patient was a man who had lost all faith in his surgical management after complications, which were inadequately explained to him.  This man has a very high level of formal education in biomedical sciences and simply did not believe he was being told the truth about his problems, or what the solutions should be. (all this complicated by his care originally being under a private provider, all causing him suspicion about their motivation to care for him once his original procedure was completed.)

On the other side of the desk, trust in the face of cultural norms and heuristics like “trust no one, assume nothing, and give oxygen” and in the face of a common view that doctors have superior understanding and knowledge about most things (our “say it with confidence and you will probably be right” approach) is difficult.  If you add in the conflicts of interests generated by fee for service private providers, there are increasing numbers of reasons why trust is so hard to build.

I don’t think there are any easy solutions, or and rules of thumb which necessarily help to resolve these difficulties in establishing a trusting relationship between doctor and patient, and sometimes it is absolutely appropriate to mistrust the information one is given, or an individual’s reliability but I think we should try to overcome mistrust as a default position.

Far better to give our patients and colleagues some credit, and enter into a more equal relationship wherever possible, than to alienate patients, and create divides where usually we all have the same aim of achieving a diagnosis and instituting a management plan with ultimate aim of improved health.

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