Trust      Trust is the glue that binds one human to another. It is the foundation which brings each of us peace and comfort, tranquility and calm. Without trust we are shipwrecked on a sea of confusion, insecurity and fear.      Trust is not easily achieved and often takes time to be affixed to the soul, as is the case with the building of friendship or love. Yet regardless of how long it takes us to achieve a sense of trust, it is this human feeling that allows us to feel safe and protected.      In the dispensing of medical care, trust is paramount. Patients who trust their doctor to help them through the rigors of maintaining or attaining good health are rewarded by a sense of peace. Without it patients are often confused and afraid. It is this trust between patient and physician that is critical to an effective relationship and vital to achieving positive results.        When strapping yourself into an airplane seat, that sense of trust comes automatically. You are about to be lifted 35,000 feet into the air and flown to a destination hundreds or thousands of miles away, yet, you nonetheless feel an element of trust. Obviously, part of that trust comes from the fact that you know it takes an incredible amount of training and experience to become an airline pilot. However a more guttural reason comes from the understanding that these unknown men and women sitting in the cockpit have a self-serving reason to assure your safety. Your well-being is tied into their well-being. If you go down, they go down. Hence, you are infused with an almost instantaneous feeling of trust.      It is this same level of trust that is so critical to the relationship between a patient and doctor. In most instances, however, that feeling of trust takes more time to develop. Knowing that your doctor has passed the rigors of years of medical training, has been certified by a number of prestigious organizations and has had years of medical experience, is not enough to guarantee unconditional trust as occurs with an airline pilot.      Because of this, an additional layer is necessary to connect doctor and patient to create a feeling of closeness. One way this can be achieved is as simple as casual conversations during office visits. The more our patients know who their physician is as an individual, the more our patients will feel a sense of caring and trust.      I have often marveled at the fact that many of my patients, once feeling this sense of trust, will allow me to make critical decisions for them in times of their greatest need. I am honored by this trust, yet I know that it did not happen just because I wore a white coat, carried a stethoscope and was called “Doctor.” While I did have all the trappings of a physician, my patients began to feel a sense of trust in my care because they also began to know who I was and what were some of my fundamental thoughts and beliefs.      The more each knows about the other the better the physician is in taking care of his or her patient and the more the patients feels trust in the physician. In an ever-increasing medical technological environment in which human touch is easily replaced by machines and drugs, it is imperative for doctors to achieve and maintain a patient’s trust through expert care dosed along the way with personal interactions.      A 2002 survey revealed that while Americans have great faith in each other, they have lost considerable faith in certain professionals, such as CEOs, stockbrokers, Catholic priests and HMO administrators. The question is, are doctors next? While society in general still trusts and respects doctors, we may soon find our profession suffering a fate similar to that of other professions. In some ways, we are already beginning to witness erosion of trust in medical care.      Consider the following: two Institute of Medicine reports, one claiming that there were as many as 98,000 accidental hospital deaths each year, and a report critical of the disparity of medical care and outcome experienced by minorities in this country; sporadic reports of doctors performing unnecessary operations or operating on the wrong part of the body; reports of radiologists missing breast cancers when reading mammograms; doctors implanting organs from donors with the wrong blood type to critically ill recipients; an incident in Boston where a surgeon actually left the operating room during surgery to make a bank deposit.      There is also a growing concern of conflict of interest by physicians as they attempt to maintain a workable bottom line in an era of managed care medicine. It has been reported that nine out of ten medical experts who participate in writing national guidelines for treating numerous diseases and conditions have financial ties to the pharmaceutical companies that manufacture the drugs included in the guidelines and that these financial ties are almost never disclosed.      In addition, recent studies have revealed hormone replacement for post menopausal women was associated with an increased risk of heart attacks, thereby totally changing recommendations made by doctors on how to treat menopause; studies revealing an increased death rate in patients using the highly recommended arthritis medications; newly released warnings that medication used to treat adolescent depression could lead to suicide. Is there any wonder that Americans are beginning to ask the question, “Who can we trust?” Patients yearn for a caring, and trusting relationship with their physicians. To build trust in today’s environment, doctors need to not only administer professional care but also show patients they care about them by revealing their personal, emotional and humanistic side.      There are many ways this can be achieved. In addition to adding casual conversation, doctors should share personal life experiences or take the time to discuss an important issue of the day during office visits. Physicians can also show patients they care by sitting on the side of hospital beds, holding a hand or putting their arm around a patient, writing condolence letters to a patient’s family, attending a patient’s funeral or personally calling patients with important medical test results.      Physicians need to state what is known or not known to be medically proven by evidence-based medicine when discussing diagnosis and treatment and to make sure their patients understand the difference.      Because we do not have all the answers, it is our responsibility to assure that our patients are fully informed on the risk-benefit aspects of medical treatment plans. We must also provide a foundation of absolute confidentiality and truth telling as we dispense care to our patients. It is vital that we be our patients’ most ardent advocate. Patients care very much how their doctor feels about what happens to them, and these feelings can significantly influence general attitudes about the medical profession. By learning more about us and witnessing our personal, emotional and humanistic side, patients can develop the trust that is paramount to the practice of quality medicine.      If physicians are to avoid the loss of trust that so many other professionals have encountered, we must pay attention to these simple measures. It is possible, in this confusing and frustrating era of medical practice and malpractice claims to show patients that we care and that we can be trusted. In a world where the house-calling physician no longer exists, it is vital for doctors to strive to regain and maintain trust in the medical profession.