Trust relations in health care—the new agenda

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Abstract
Trust has traditionally been considered a cornerstone of effective doctor–patient relationships. The need for interpersonal trust relates to the vulnerability associated with being ill, the information asymmetries arising from the specialist nature of medical knowledge, and the uncertainty and element of risk regarding the competence and intentions of the practitioner on whom the patient is dependent. Without trust patients may well not access services at all, let alone disclose all medically relevant information. Trust is also important at an institutional level, as trust in particular hospitals, insurers and health care systems may affect patient support for and use of services and thus their economic and political viability. However, in our so-called post-traditional order1 is trust still necessary? The days of ‘doctor knows best’ when patients blindly trusted in and deferred to medical expertize are fast becoming a distant memory in industrialized societies where the consumer is dubbed ‘king’ and where the ‘expert patient’ expects to play an active part in decision-making regarding their treatment. Might lower levels of trust, or in fact distrust, be merited in light of medical errors, drug side effects, and the slow adoption of ‘evidence-based’ medical innovations and clinical guidelines? In this paper we set out how and why trust relations in the healthcare context are changing, arguing that although trust may now be more conditional it is still vitally important for both health care providers and institutions.
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