Differentiating between trust and dependence of patients with coronary heart disease: furthering the sociology of trust

Abstract

Sociological health research on the concept of trust has been bedevilled by its multivocalities. This article extends Luhmann's attempts to clarify a sociology of trust. Luhmann argued a semantic distinction between trust and confidence. In this article, we use empirical data on patient 'trust' in doctors to argue that there is also a semantic distinction between trust and dependence. We conducted 37 semi-structured interviews with patients with coronary heart disease in Adelaide, Australia in 2008 and 2009. Our findings indicate that risk, familiarity and time were critical to understand the distinction between trust and dependence. We argue that patients in situations of emergency (heightened risk) 'depended' on, rather than trusted, doctors, given the patients lack of familiarity with their doctors. Time was a mediating factor, as the more 'urgent' the situation, the more likely it was that dependence came into play, since the situation was 'unfamiliar'. Rather than juxtaposing trust and dependence, in this article we show how dependence may coexist with trust in the health care system in times of emergency.

Trust in health care encounters and systems: a case study of British pensioners living in Spain

“…Further, the robust criticisms of other aspects of the Spanish state suggest this is not merely courtesy bias from participants answering questions from a Spanish-identified interviewer. Neither does it straightforwardly represent mere dependence (Meyer and Ward 2013), a need to trust, or to rationalise current choices to minimise regret because there are no other options: participants such as Rosemary and Andrew were not unusual in having both the financial and other means to return home for treatment if necessary, or to pay for private care. That Spain, for many participants, would be the ‘obvious’ choice if future health needs arose, even if other options were available or (on occasion) when atrocity stories could be told about things that had gone wrong, suggests a degree of what could properly be called trust.…”

“…Trust becomes salient in situations when there is a realistic choice to make: perhaps to undergo an operation where the risks and benefits are uncertain, or to choose one health-care system over another. Meyer and Ward (2013), in considering the case of patients at high risk, suggest extending Luhmann's distinctions to include dependence, to describe situations in which patients have no option but to trust.…”

Improving Access to, Use of, and Outcomes from Public Health Programs: The Importance of Building and Maintaining Trust with Patients/Clients

“…In other words, most members of the public do not have in-depth knowledge of screening programs, and therefore rely on “trusting” particular public health practitioners or public health institutions—this “trust” allows them to make decisions and allow for their imperfect knowledge (75). …”

‘Trust my doctor, trust my pancreas’: trust as an emergent quality of social practice

“…Much of this work has concentrated on what trust means in an abstract sense, whether in terms of its definition, its distinctions with related terms, or by developing a set of analytical principles (see for example [13, 14]). In this literature it is commonly said to be something we can ‘have’ , that can be incrementally increased and built up, or decreased and even lost altogether [15].…”

“…This general phenomenological approach highlights how objects and other non-human actors can shape the assumptions and interpretations actors make and that trust is actually a very fluid and varied entity (see for example [24, 25]). By doing so, this empirical work has led scholars to emphasise the contingent, contextual nature of trust [26], and that frequently there are other relevant actors beyond the classic dyad [27]. …”