Priority of Trust


Dr. Tashel Bordere presented at the 2016 Conference of the Association of Death Education and Counseling on the topic of “Trust-Building Among African-Americans in End of Life”.  In her presentation, she suggested that the issue may not be why there is mistrust but why should there be trust. This helpful and provocative suggestion leads to an even larger question: What if establishing trust, not understanding, was the highest priority when healthcare providers communicate with patients and families?

Communication is one of those things that we do all the time, whether we intend to or not, yet also one of those things where our efforts often fall short. The typical first goal of good communication is mutual understanding where all involved well understand the concerns and perspectives of all others involved. A common pitfall is the focus on getting others to understand our concerns/perspectives while not putting equal focus on understanding the concerns/perspectives of others. Much effort is needed here to balance the scales toward true mutual understanding. If we can find a place of balanced mutual understanding, then we have the opportunity to work together toward developing mutual goals and plans to pursue those goals.

But what if this our ordering of communication goals is not quite right? What if “mutual understanding” is a secondary goal and the more appropriate primary goal is trust—establishing a trusting relationship between healthcare team and patient and family? From a healthcare team’s perspective, the goal when entering into a difficult discussion, especially one with potential life and death consequences, is for the patient/family to understand the information being shared so they can make appropriate and realistic decisions (from the team’s point of view). While this goal is understandable and reasonable, it is inadequate. First, it leaves out the goal of understanding on the healthcare team’s part of the patient/family perspective. More fundamentally, however, it too often skips over or assumes trust that has not be established or confirmed. Trust is not a given and should not be assumed. Trust needs to be earned, nurtured and supported. Without trust, there cannot be good mutual understanding of concerns and perspectives, and without trust, we will not identify mutual goals and work towards them as partners. Without trust, efforts to establish mutual goals and plans will continually falter and flail. Trust is primary, and being such, its establishment deserves and needs first place in the priority list.

The good news is that trust, mutual understanding, mutual goals and plans are not mutually exclusive—they are quite interdependent. Making trust a first priority does not change everything but it reorders everything. It’s a difference of focus. How would we act and communicate differently if we, as healthcare providers, went into interactions with patients and families with the priority that when we’re done, whether we agree or disagree, the patient and family trusts us, believes that our intentions are compassionate, well-informed, respectful and honest? That whether or not the patient and family fully “get” what we are trying to communicate, they trust us as much or more when we finish the conversation as they did when we began the conversation? Trust as first priority would change us and our interactions.

Tashel Bordere reminds us that trust should not be taken for granted. There are many reasons for people of all backgrounds not to trust healthcare providers, but trust is foundational and absolutely necessary if we are to meet our obligations to help the sick, the dying and those that love them in their most vulnerable times. Thoughtfully acknowledging trust as the first priority can change communication and relationships between healthcare teams and patients and families for the better and for good.