Trust: A reciprocal relationship between us and patients

AMA Leader Commentary. By Cecil B. Wilson, MD, May 7, 2007.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all AMA members from Cecil B. Wilson, MD, chair of the AMA Board of Trustees.

Americans have given their physicians enormous responsibility and, with it, great trust. Trust is the cornerstone of human relationships, and nowhere is it more important than in the patient-physician relationship.

Trust in this context involves a confidence that we will -- and can -- do what is best for our patients.

Our patients hold the expectation that we will be a trusted friend, someone in whom they can confide some of the most sensitive and private aspects of their lives. They tell us things they would not tell their spouse or their priest. They do so knowing that we need to know and that they need not fear our discretion in keeping matters private -- and privileged.

That trust level is continually earned. It is added to literally with every patient contact. It is not something we receive by a demand or command. It is something patients extend to us initially because we bear the title of physician -- and over the long haul, by how we treat them.

Each quarter, Harris Interactive measures the confidence Americans place in their physicians. The current results:

A total of 88%, nearly nine out of 10, responded favorably to the question, "How much trust do you have in your physician?" One American in four (24%) holds complete trust; 39%, a great deal of trust; and 25%, a fair amount of trust.

A recent Gallup survey found that 33% of Americans approve, and 60% disapprove, of the job Congress is doing. That is a dramatic difference from the trust or approval Americans place in physicians. Congressional ratings were as low as 21% a year ago. Physician ratings have never fallen below 82%.

This is especially impressive when you consider that trust is for the long haul. It isn't established overnight but relies on a consistent pattern of action and reaction, a reciprocal relationship between us and our patients.

Much of it stems, I believe, from the trust we demonstrate in our patients.

Ralph Waldo Emerson observed, "Trust men and they will be true to you; treat them greatly and they will show themselves great."

Webster's definition of trust describes it as: "Assured reliance on the character, ability, strength or truth of someone or something."

Trust is crystallized honesty, consistency, fairness and especially transparency. Without transparency, without doing what we say, we earn less trust than we could. Transparency requires excellent communication skills, openly articulating what we otherwise might assume that the other understands.

Our patients are capable of many things, but they are not mind readers. It is no insult to a patient's intelligence to speak clearly, completely and confidently. That trait earns trust. The alternative leads to confusion and mistrust.

Patients look to us to speak out on their behalf. And they have every right to do so for, as Winston Churchill put it, "When eagles are silent, the parrots begin to jabber."

That is why the AMA works diligently to earn the trust of the American people by clarifying the issues facing our patients. That is why we explain the consequences of ignoring the problem of the uninsured, for example. Or ignoring the implications of repeated physician payment cuts under the Medicare physician payment formula (the sustainable growth rate). Or about unhealthy lifestyle choices that end in costly, avoidable disease, accidents and, all too often, death. Or about regulatory and insurance hassles that interfere with the patient-physician relationship.

Without trust, we cannot achieve the high calling of our profession. Without trust, we have no credibility.

Without trust, we might as well close up shop and look for something else to do.

But with trust, we are able to accomplish the miracles of modern medicine on a daily basis, thereby increasing the storehouse of trust upon which to draw tomorrow.

And our ability to do just that makes me trustingly optimistic about the days ahead.

Dr. Wilson an internist in private practice in Winter Park, Fla., was AMA president during 2010-11. He served as chair of the AMA Board of Trustees during 2006-07. Learn more about Dr. Wilson at the AMA's biography page.