Is there a moral duty for doctors to trust patients?
J Med Ethics. 2002 Apr;28(2):77-80.Is there a moral duty for doctors to trust patients?Rogers WA.Department of General Practice, University of Edinburgh, UK.AbstractIn this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests.
Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors.snipSometimes doctors may distrust patients’ accounts of treatment failures, doubting either their veracity or their competence in having complied with the treatment. A reaction of distrust may be part of a natural human tendency to distrust accounts which one wishes to disbelieve. This kind of distrust can be likened to shooting the messenger, especially when the doctor feels that medical science is on her side and that the patient should be better. If they are not, this must surely be due to their incompetence as patients.
Part of the medical role in publicly funded health services is that of guarding access to resources. This role suggests another possible reason for distrust of patients’ symptoms. Refusing a patient access to an investigation or treatment may be easier if the doctor does not believe that the patient is telling the truth about her symptoms.
If accounts of symptoms can be distrusted, they may then be discounted, in which case there is no need for further attention. This may be an easier option a times than admitting patient need which cannot be met by the existing resources of health services (raising the question as to whether private medical care circumvents this cause of distrust). In addition,admitting patient competence in assessing their own needs takes diagnostic power and authority away from doctors. This undermines the medical role of resource guardian, providing a further possible reason to distrust patient competence.
The social context of medicine may also contribute to distrust of patients. Many medical interactions occur between strangers and under pressure of time, requiring doctors to make very swift decisions about how much to trust the stranger-patient. There is no time to consciously reflect on the warrantedness or otherwise of distrust in these situations.snip