A Matter of Trust

Most people trust doctors. In fact, we trust doctors despite an increase in malpractice cases in recent years, and an increase in so-called "adverse events" affecting hospitalized patients.

In the Gallup organization's annual polls looking at the public's perception of honesty and ethical standards among professionals, doctors typically rate near the top of the list. They don't rate quite as high as nurses (who ranked highest in 2004 with a score of 79%, while doctors achieved 67%), but they're well ahead of car salesmen, HMO managers, insurance salesmen, and advertisers – all close to or at the bottom of the list.

Gallup's numbers are corroborated by other polls, such as the 2003 Reader's Digest Trust Survey, conducted by Ipsos-Reid, in which doctors came in at 85%, well ahead of politicians and the lowly car salesman. Moreover, it seems we trust doctors more than we did in the past. Again, according to Gallup, the average for doctors between 1976 and 2000 was 56%, much lower than it is today.

So what is it that makes us trust doctors? And is that trust based on a solid understanding of what doctors do or who they really are? Maybe not.

The following is therefore submitted as a spirited and skeptical response to the pollsters and their conclusions. (Admittedly, it's a response that can trace its roots back to the first time the author's mother took him to a complete stranger to have a needle stuck in his arm.)

The (Shaky) Foundation of Trust

Now, first of all, we're usually at our most vulnerable when we go to see doctors. We're sick, we want to get better, we're desperately looking for answers, and in the most extreme cases, we may even be asked to wear a hospital gown. And think about it: Is anyone in a frame of mind to discern the truth of a statement when his or her derrière is exposed to the world?

What about the huge profits that pharmaceutical companies have achieved in recent years? According to the German Association of Research Based Pharmaceutical Companies (Verband Forschender Arzneimittelhersteller e.V.), worldwide sales of pharmaceuticals increased by 28% between 2000 and 2003. Mull it over for a moment. If you really want to know what drives these profits, ask yourself who prescribes your drugs. It's certainly not your hairdresser.

Then there's the famous Hippocratic Oath. There's nothing that says the age-old maxim ascribed to Hippocrates, primum non nocere ("first, do no harm"), necessarily means that doctors have to tell us the truth. Suppose they believe the truth will harm us? So much for trust.

And that's not even taking into consideration the topic of doctors' personalities. It's no secret that medical schools try to fine-tune candidate selection on the basis of personality types. Some have even produced studies that look at whether or not temperament played a role in the specialty their students eventually chose. Others have grappled with the differences in personality profiles between male and female medical students, or tried to determine the "surgical personality."

Surgeons are particularly interesting in this respect. In addition to possessing the ability to problem solve and deal with pressure (which are understandable), surgeons are also typically intuitive. And they're risk takers. This means that the person you've likely only met once before – the person that's wearing a mask and holding a sharp knife – likes to use his or her sixth sense and take chances. In fact, s/he may even have been accepted into medical school because of it. But you trust them, because they're doctors.

What about the established reputation doctors have for being arrogant, abrasive, opinionated, stubborn, and aloof? If a car salesman walked onto the lot like a third world dictator, was rude to you, didn't answer your questions directly, and then left as quickly as he arrived with a condescending, "you'll be fine" – would you buy a car from him? Maybe, but only because you were in shock.

At end of day, this skeptic believes that it would be nice if the Gallup did a poll looking at whether or not doctors trust their patients. Or better yet, how high they rate our relative intelligence.

This brings us back to the original questions: Why do we trust doctors? Why do doctors consistently rate high when it comes to trust and the professions? Well, why do we watch reality TV, eat deep-fried food, and pollute the environment? When it comes down to it, because we're all sick, sick, sick.

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