Building Trust and Future Directions

Trust in physicians generates better health outcomes. In this capstone chapter, the contributions of developmental theorists (Erikson, Winnicott, Mahler, Ainsworth and Bowlby) help to understand the growth of mature trust. Virtue theory informs the development of competence, compassion and wisdom in the physician to ensure their trustworthiness. Education in bioethics and professionalism are critical dimensions of the curriculum, while modelling and supervision have long been core training techniques. Communication skills training fosters truthfulness, patient-centeredness and shared decision-making. Other communication strategies include question prompt lists, consultation summaries, audio-recordings of key consultations, as well as written and online information. The consensus achieved by a multi-disciplinary team meeting conveys much reassurance about treatment plans. When adverse outcomes or errors occur, empathy, honesty, education, apology and taking responsibility are hallmarks of the moral approach. Openness to discuss death, dying and the existential realm are critical to optimal cancer care. The media can help build health literacy but are also a source of damaging misinformation. Learning to provide an “internet prescription” is thus a vital skill. Understanding explanatory models of illness—biomedical, folk and supernatural—aids culturally-sensitive care. Overcoming health disparities is a basic human rights issue that is essential to building trust in the socio-economically deprived, mentally ill, disabled, and vulnerable communities.