Earning Patient Trust: More Than a Question of Signaling

Abstract

Laura Specker Sullivan's article “Trust, Risk, and Race in American Medicine” is a philosophically grounded and highly practical call for medical professionals to take on the task of comprehending the sources of patients’ mistrust. This is not only a clinical competence but also a moral obligation, in particular, when mistrust is warranted—as with African American patients who rely on medical institutions that have breached and continue to breach the trust of their communities. While Specker Sullivan focuses on how clinicians can signal comprehension once it has already been attained, I wish to step back and examine the nature of the efforts to gain knowledge. The effort to comprehend requires, at a minimum, the following actions: educating oneself about medical racism, examining one's implicit biases, and engaging, with empathic curiosity, with the patient or family members in the clinical encounter at hand.

Meeting the challenges of the 21st century: the fundamental importance of trust for transformation

“…Trust also promotes constructive dialogue, helping to resolve disagreements. Finally, trust fosters empathy, something that patients value highly [ 25 ].…”

Placing Trust at the Heart of Health Policy and Systems

“…The same is true for minority populations, defined by their ethnicity, sexuality, or other characteristics, that have experienced discrimination, placing an obligation on clinicians treating them to be aware of their history. 20 Recognising the multiple and interconnected drivers of people’s mistrust has implications for how trust is measured among individuals and groups as well as for identifying what is needed to (re)built trust and reform social and political institutions so that they are trustworthy , emphasising the need for constant reflection on how health systems can remain trustworthy for everyone. A similar logic applies to building trust among healthcare workers, whose trust may be lost for very different reasons including the embedding of blame or litigious cultures within the healthcare sector, which will in turn require different forms of inquiry and actions to (re)build trust.…”