Trust in Healthcare

Concept

Trust has been defined as “the optimistic acceptance of a vulnerable situation in which the trustor believes that the trustee will care for the trustor's interests.” According to Lucy Gilson, this definition emphasizes several key features of trust. First, it implies that trust is a relational notion; that is, it emerges from a set of interpersonal [Page 1154]behaviors. These behaviors are guided by sets of institutional rules, laws, and customs. At the microlevel, we can distinguish several types of trust relations: between an individual patient and a physician, between two physicians, and between a physician and his or her manager. At the macrolevel, we can consider patient and public trust in physicians and managers in a particular healthcare organization and in the whole healthcare system. Second, the definition of trust involves a notion of vulnerability and risk, and it is rooted in the expectation that the other will have concern for one's own interests. That is, trust appears to be necessary to cope with situations that have an element of uncertainty regarding the motives, intentions, and future actions of other individuals and organizations that we depend on. Trust appears to be particularly important in the healthcare area because this is a setting characterized by uncertainty regarding the competence and intentions of the physician on whom the patient is reliant. The need for interpersonal trust emerges from the vulnerability associated with being ill as well as the information asymmetries and unequal relationships specific to the medical domain. This explains why most definitions of trust combine expectations about ability, competence, and knowledge of the physician with expectations about his or her ethics, integrity, and motives.

Impact

What are the consequences of trust in the healthcare system? There is substantial evidence that trust mediates healthcare processes. In fact, it has been argued that trusting patient-physician relations have a direct therapeutic effect, although evidence to support such claims is still scarce, mainly because of the lack of intervention studies examining the effect of trust on health outcomes. There is a broad agreement that trust has an indirect influence on health outcomes through its impact on patient satisfaction, adherence to treatment, and continuity with a provider. Trust also encourages patients to access healthcare and to disclose the information necessary to make an accurate and timely diagnosis. Trust, therefore, underpins patient behaviors important for effective treatment. Trust is also a quality indicator, with patients suggesting that high-quality doctor-patient interactions are characterized by high levels of trust. From an organizational perspective, trust is believed to be important in its own right; that is, it is intrinsically important for the provision of effective healthcare and has even been described as a collective good, similar to social capital. Specific organizational benefits that might be derived from trust as a form of social capital include the reduction in transition costs due to lower surveillance and monitoring costs and the general increase in efficiency. It has been argued that trust also has some costs and dangers. Although trust may provide legitimacy for the exercise of power, trusting too much, without caution, may also enable the abuse of power in the form of exploitation, domination, or conspiracy against others. This is a particular danger for healthcare given the vulnerability of all patients, but particularly those from disadvantaged backgrounds, in relation to healthcare providers.

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