Examining Trust Behind Closed Doors: In the Clinic and the Home

“Good relationships are built on trust.”

This age-old adage is ingrained in the minds of children from the time that they learn how to share and play properly with others through the passage of their first experiences with romantic love and companionship. Trust is conventionally defined as a “firm belief in the reliability, truth, ability, or strength of someone or something.” Although most people agree on the importance of trust in a relationship and may feel as though they can gauge their own feelings of trust in someone or something, it is more difficult to point to distinct dimensions of said trust or to analyze exactly how it was fostered.

In a study on trust in physicians and medical institutions, the authors identified four distinct dimensions of trust as well as a fifth, ‘global trust’ dimension (Hall, Dugan, Zheng, & Mishra, 2001). The dimensions used were fidelity, competence (as related to minimizing errors and maximizing effective communication), honesty, and confidentiality. The authors define these dimensions in relation to a clinician-patient relationship, but I think that these dimensions could be similarly used in the analysis of a personal trust relationship. The global trust dimension is a catchall for elements that have a strong relationship to other dimensions without exclusively fitting into one, which is meant to also capture a more holistic aspect of trust.

Trust in physicians has been demonstrated to be positively related to adherence to treatment regimens, to patients not changing their physician, to fewer disputes with physician, perceived effectiveness of care, and improvement in self-reported health (Hall, Dugan, Zheng, & Mishra, 2001). If trust is vital to patient cooperation and thus patient health, it would seem that measures of trust should be administered to ensure the existence of a healthy patient-clinician relationship. An assessment of trust could be given multiple times over the course of the clinical relationship, both to determine what may need to be improved in the relationship, as well as to determine the antecedents and consequences of fluctuations of trust. Further, a test which computed scores for each dimension of trust as well a holistic measure could be effectively used as, while the dimensions have not been shown to relate strongly to one another, they all are strongly associated with global trust. In this way, if only one dimension is failing in that time, this could be worked on specifically to achieve a high level of global trust. Tests such as these could also benefit couples in intimate relationships. By identifying weaknesses in the trust relationship, couples in counselling could identify significant barriers to achieving an entirely trusting relationship, with the knowledge of which dimensions are most critical to their relationship health and success.

While analyses of trust may be criticized as being too time-consuming to be clinically effective, it may be more inefficient and potentially dangerous for clinicians to spend time administering treatment plans that will fall on deaf, and untrusting, ears.

Hall, M. A., Dugan, E., & Mishra, A.K. (2001). Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?. The Milbank Quarterly, 79 (4), 613–639.

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