Trust is usually defined as a willingness to rely on the actions of another party. In this sense, it is a behavior more than it is an idea. Trust can also spring from a choice to care for another person, even at one’s own expense. Rock climbing, in my opinion, illustrates trust in its most simple and straightforward manner because sharing a rope while suspended hundreds of feet off the ground constantly puts two lives in danger; both leader and follower, decision-maker and passive participant. Errors are unforgiving and often deadly, and for this reason are virtually intolerable, for even a sentinel event can jeopardize a partnership or one’s life.
The famous marriage counselor and clinical psychologist, John Gottman, says that while trust is a major building block for a successful relationship, the reality is that trust is built slowly over time. Whether in marriages, professional partnerships, friendships or collegial acquaintances, trust requires consideration and empathy for one another’s feelings. A foundation of trust is necessary because eventually all relationships must face the crisis of a betrayal.
Usually, Gottman says, betrayals accumulate little by little, although other times they occur like a sudden splash in what might otherwise have been a calm sea. They may be real or simply perceived, but like all moments of crisis, they provide an opportunity to either rethink the boundaries of a relationship or build more trust.
In rock climbing, clear communication and mutually observable demonstrations of competency are reassuring and reliable indicators of growing trust. In medicine too, a doctor’s ability to clearly communicate with patients and team, as well as clearly demonstrate competency, quality of care, and focus on a patient’s needs help elicit trust. At the same time, doctors, health care administrators, social activists, and politicians must engage in systems-based analyses that assure the application of scientifically-proven therapies and efficacy-based innovative new technologies.
In the field of interventional pulmonology, it is tempting to believe that everything we do is in the best interests of our patients. In fact, our patients “trust” us to do so. Yet, vast sums of money, as well as patient and family suffering, may be expended in what ultimately becomes futile care. There is little oversight of physician decisions in these cases, and the emotional costs on medical providers, patients, and families are poorly documented. Professor George Lundberg, a former editor of JAMA and CEO of WebMD said that “futile care” was a contradiction in terms, and what was needed most in defined situations was “attentive care” from physicians capable of listening to their patients. Sadly, training in this domain is usually lacking from our medical conferences that focus on the use of technology and complex procedures used to diagnose and treat patients with lung, airway, and pleural disorders.
If we are to maintain the trust of colleagues, patients, families, and institutional leaders I propose that we work more purposefully on integrating workshops and lectures on medical ethics, communication, and clinical decision-making not only into our training programs, but also in our journals, regional meetings, and international congresses.