Can I Trust my Doctor?

We all recall President Reagan’s adage, trust but verify, with regard to the then Soviet Union.  President Reagan’s choice of words indicated that trust could not be assumed.  I challenge this notion as I feel that to trust another person, an organization or even a country that trust must be assumed to exist.  That’s what trust means.  Conversely, if one has to verify its presence, then true trust is clearly not there.  If a spouse, for example, hires a private investigator to prove that his or her partner is behaving honorably, is trust present?

I think that overall the public trusts their doctors, although they are wary about the medical profession writ large.  The public may view their physicians in the same way that it views politicians – they see systemic dysfunction and self-interest in both professions but folks give higher integrity marks to their personal doctor or representative.  Often, patients who I know have confidence in me voice criticisms over various frustrating aspects of the medical world including billing absurdities, poor physician access, waiting times in emergency rooms, lackluster bedside manners, costs of pharmaceuticals, the reality that medicine is a business and the sense that they are outmatched in an unfair fight. 

How much trust can a patient have in a system that won’t cover a drug that they need to get well?

There is a dichotomy between a strong bond between most patients and their doctors and a deep skepticism the public has with the medical-industrial complex.  I understand this both as a physician and when I have been a patient.  If medicine has truly morphed into a business, can we expect it to behave reliably as a professional calling?  I suggest that readers review the very brief fable of the Frog and the Scorpion which illustrates my stinging point very well.  I’m not saying that the profession cannot behave nobly, only that there are forces present opposing this. 

"It's my nature."

If trust between medical professionals and patients erodes, then the doctor-patient relationship is fractured and optimal medical care may no longer be possible.  A patient needs to know that when medical advice is offered, that the only consideration is the patient’s welfare.  I still have patients query me from time to time if the reason I am counseling against a diagnostic test is to conform with insurance company policy.  And patients need to be truthful with us.  If physicians are misled about addiction issues or if patients are taking their medicines as prescribed, then the medical recommendations may be wrong.  Tell the truth.

Overall, I think the health of the doctor-patient relationship is intact, but like any relationship, it needs to be nurtured and protected.  Each side has a responsibility to maintain it.  If one side is falling short, then the partner needs to call him or her out to restore the equilibrium.  That’s how a trusting relationship stays strong.