Decisions in a Bed of Trust, Part I

Submitted by jeplatt on Mon, 08/27/2018 - 14:02

Trust has long been recognized as a cornerstone in the relationships that support our health and well-being.  It is a key element that supports the doctor-patient relationship, facilitates team-based care giving, and gives license to the medical profession to retain autonomy.  It is so important because it is a mechanism that upholds accountability and reliability. But trust in medicine is quaking. Trust in the medical profession declined 40% between 1966 and 2012 and less than one-quarter (23%) of Americans has confidence in the health system[1].    

Trust has been defined and studied in a variety of fields – sociology, economics, business, psychology – but can generally be defined as “a willingness to be vulnerable to another for a given set of tasks.” Trust is built over time and on a foundation of agreements, expectations to fulfill those agreements, and a track record of honest efforts to meet those expectations. In interpersonal relationships between physicians and patients, the physician prioritizes the needs and health of the patient.  The patient, in turn, reveals personal information, and relies on the skill and knowledge of health care providers, and the health system more generally to treat her fairly, competently, confidentially, and without prejudice.

General trust in the health system relies the processes, governance, and fidelity of institutions and professions to prioritize the needs and interests of patients.  As systems grow larger, it becomes more challenging to see, know, and form relationships with individuals.  When neither physicians nor other health providers are afforded the time to build relationships, care and confidence suffer.  Trust suffers.

To the extent we can use the new tools of health technology to help use time more effectively, improve communication, improve outcomes to meet or exceed expectations and build relationships, we have an opportunity to heal and build trust.

Building trust

The good news is that trust can be built and the “crisis” in trust is not without hope.  Shared decision making and creating avenues for honest exchange of information are one place to start.  Improving systems so that they address implicit biases and care for populations just as well as they care for individuals is the hope and challenge of the next century.  To accomplish this, we need the cooperation of both individual providers and patients, as well as the systems in which they operate.  Specifically, systems and individuals within them can: 

  • Be more transparent and openly accountable to patients and providers.  
  • Show respect and uphold the values of diverse stakeholders, 
  • Empower people to take the time to build, foster, and steward trust in the relationships that make systems run.
  • Leverage the leap into the digital age, to “hardware” trustworthiness into systems in the form of automated reliability checks and communications systems.  

[1]Blendon RJ, Benson JM, Hero JO. Public trust in physicians—US medicine in international perspective. New England Journal of Medicine. 2014 Oct 23;371(17):1570-2.