One of the key elements contributing to a successful, meaningful doctor-patient relationship is trust. In any relationship, there are two parties and whilst trust is generally understood in terms of patients needing to trust doctors, within the context of the doctor-patient relationship, it is as well to consider that doctors need to trust patients too.
The doctor
When one speaks of trust in medicine it is expected that patients will be able to do just that – trust.
· Patient vulnerability has to be respected at all times, likewise confidentiality.
· It is rightfully assumed, and expected, that all doctors have minimum levels of competence acquired through study and training.
· It is also anticipated that in any clinical situation a doctor will approach the patient with compassion and understanding – listening attentively to the patient’s account of what has brought them to the doctor.
· Specifically it is understood that as practitioners they will do no harm, always do good, and respect patient autonomy and decision making as well as that, to the best of their ability, they will ensure patients receive what they require in terms of treatment (remembering that resource constraints often determine what treatment is possible, whatever the ideal might be). I do not think there is a doctor who would not subscribe to adhering to the aforementioned principles.
A lack of trust will surely inhibit the patient as well as undermine the possibility of a meaningful relationship and a satisfactory clinical outcome. Generally speaking, the burden of trust does fall on the shoulders of the medical practitioner i.e. they are the ones who need to be trusted.
The patient
Relationships are bidirectional, albeit at different levels depending on the nature of the interaction. One may ask, how is trust a patient issue? What situations could arise where this might be the case? There are several scenarios that come to mind: compliance, honesty and safety. Whilst these may appear to be discrete issues, they are inter-related.
· As a doctor, I listen, I assess and I share my thoughts and make recommendations for care. If the patient and I reach consensus and agree on a way forward – compliance is assumed. Outcomes generally depend on compliance. And if not compliant – as a doctor I need to know…there will be reasons that need to be explored, in a spirit of trust.
· The doctor needs to trust that the patient has been honest in contributing fully to the consensus reached. Once the patient leaves the doctor’s room – the doctor has to trust that the patient will do as agreed. Moreover, it is assumed that in reaching an understanding of the patient, in order to make a diagnosis, that the patient has not intentionally omitted detail required by the doctor to arrive at a diagnosis, upon which treatment is based. The doctor has to trust the patient.
· What about safety? It is not unheard of for doctors to be verbally as well as physically and violently assaulted by patients – thankfully a rare occurrence, but doctors need to have a level of awareness of unpredictability with certain patients under certain circumstances. The doctor has to trust that as a caregiver they will not fall victim to such behaviour. A hostile environment is not a therapeutic one.
And so, the requirement of trust is not only fundamental but indeed also bidirectional with both doctor and patient contributing albeit in different ways. A key element of healing is the relationship between doctor and patient. Trust is an essential ingredient.
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