Abstract
This paper addresses two research questions. The first is theoretical: What is trust? In the first half of this paper we present a distinctive tripartite analysis. We describe three attitudes, here called reliance, specific trust and general trust, each of which is characterised and illustrated. We argue that these attitudes are related, but not reducible, to one another. We suggest that the current impasse in the analysis of trust is in part due to the fact that some writers allude to these distinctions, but unclearly so, whilst others elide them altogether. The second research question focuses on doctor–patient interaction. Trust is often said to be central in medical encounters but this strikes us as too vague. The success of doctor–patient relations in part depends on adopting the most appropriate of the three attitudes we delineate. We argue that reliance is the appropriate attitude for most medical encounters. When circumstances do require trust, the distinction between specific trust and general trust is crucial. We describe medical encounters requiring specific trust. General trust is less often required in medicine; but it is appropriate in some cases and, when called for, it is called for strongly.
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Notes
This corresponds to Goffman’s [9] notion of ‘civil inattention’. Incidentally, the metaphor of a pyramid could be misleading in that it might suggest an evaluative hierarchy of attitudes, from the ‘base’ attitude of reliance to the more rarefied general trust. But none of these attitudes is better or more important than others, per se, any more than that one stratum of a pyramid is more important than others. Rather, our point is that interlocutors need to adopt the appropriate attitude for the context; only in that context-relative sense is one attitude better than another.
‘Trust, I will suggest, is a distinctive kind of attitude involving a distinctive state of mind’ (Holton [13]: 63).
See, for example, Möllering [17]: Chapter 5.
That reliance is necessary for specific trust helps explain why it might seem natural, and not a misuse of the term, to speak of trust in providers of contractually regulated and behaviour-led services (taxi drivers, plumbers, etc.). We are arguing that such conversational usage obscures the important distinctions we draw between interpersonal attitudes.
The tension between rational and experiential understanding of distrust is shown in Part 2, Chapter 8 of Tolstoy’s Anna Karenina when Karenin begins to suspect his wife. The abyss he looks into captures the sense of disintegration as his general trust in his wife breaks down.
This was first suggested by Foucault [6] in his description of the setting up of medical clinics; this attitude of ‘the medical gaze’ now seems embedded in medical practice.
Referring to an implantable cardiac prosthesis, Dr Denton Cooley said, ‘I felt it was partly my patriotic duty to see that this was first attempted in our country’ ([7]: 189).
As Primo Levi ([16]: 30), describing a moving though misguided attempt to prevent an explosion, wrote: ‘Competence has no surrogates’.
It is perhaps worth adding that one of the present authors, Stocks, is at the end of a long career in General Practice, one which has involved first-hand experience of the sorts of medical encounters requiring what we call general trust. Of course, this is ad hominen; but such experiences motivated our research interest in this area and support our claim that general trust is sometimes, and strongly, required of a doctor.
This is illustrated in the health visitor’s reported remark in a study of the MMR vaccine: “We would give it to them and say this is what is recommended, it is recommended, this is the information and if they ask you what your personal view is you have to say well I’m not allowed to give you that (laughter)” [2].
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Holland, S., Stocks, D. Trust and Its Role in the Medical Encounter. Health Care Anal 25, 260–274 (2017). https://doi.org/10.1007/s10728-015-0293-z
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DOI: https://doi.org/10.1007/s10728-015-0293-z