Trust Me, I’m a Doctor: The Anatomy of Trust

“The best way to find out if you can trust somebody is to trust them.”  ― Ernest Hemingway

Consider for a moment the qualities of someone you would say you “trust fully,” and someone whom you “don’t trust.”  How did you establish whether you “trusted” them – the qualities that made them trustworthy, or not?  Though we don’t talk about it often, trust is certainly foundational in our work; trust in ourselves, our care team, our colleagues, the systems we work in, the medications we prescribe, and the equipment we use. 

Perhaps even more relevant, how do our patients determine if/how much they “trust” us?  As a Family Medicine resident, I was fascinated and often quite surprised at the implicit (and often explicit) trust gifted to me by those I helped to care for.  To my amazement, many times amid dire health circumstances and facing life or death decisions, patients would ask my opinion and often value it even over that of my attending or the consultant. .  

This led me during that time to become a “student” of trust.  In my early reading, Stephen Covey, in his book “Principle-Centered Leadership,” taught me that trustworthiness is a result of an individual demonstrating both strong personal character and professional competence.  Later in my journey, one of my colleagues (regret I cannot recall who) shared with me the following “trust equation” that I have worked with and shared frequently since that time: 

  Trust = (Relationship x Competence)/Risk

Though there are other such “equations” in circulation, I have continued to find this one to be the most accessible.  Trustworthiness becomes the trust from another person when one’s “character” establishes a meaningful relationship with them (“you care about me”), and one’s “competence” is discerned (“you are providing me good care”).  Adding the variable of perceived “risk” helped me understand that trust is rarely absolute, but more often is both conditional and contextual.

Further along in my professional journey, leadership teacher Patrick Lencioni, in his classic book “The Five Dysfunctions of a Team,” instilled in me that the foundational challenge for any team is the establishment and maintenance of trust, and in the absence of it, a team will ultimately flounder.  To that end, he created the following “Personal Trust Audit” for reflection (modified slightly), using the parameters of “Usually/Sometimes/Rarely” as a gauge:

  • I am consistent with regard to how I treat others. I don’t “play favorites.” I try to use the same standards for everyone.

  • I am consistent with the messages I give people (my conversations) regarding our work.  People know what matters to me.

  • I quickly and genuinely apologize to others when I say or do something inappropriate or possibly damaging to the relationship/team.

  • I openly admit my weaknesses and/or mistakes.

  • I know others not just on a professional level, but a personal level as well. We know about one another’s personal lives and are comfortable discussing them.

  • I am continually looking for opportunities to improve my professional knowledge, attitudes, and skills.

We’re hearing a lot these days about patients not trusting clinicians, clinicians not trusting patients or each other, and both patients and clinicians often not trusting the “healthcare system.”  The causes for this are well-known.  As such, it seems wise to me that those of us in healthcare revisit the “fundamentals” of trust – relationship and competence.  It is there that we will find our way forward, with our patients and with each other.  Give it a try.  Trust me, I’m a doctor …

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The Importance of Staying Connected - With Yourself

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The Art of Taking Nothing for Granted