I think that the highest compliment that a patient has ever paid me was “I trust you.” Jane* is 54 and stopped having periods 7-8 years ago. She’d always had terrible cramps, and couldn’t wait to be done with them. On an unseasonably warm and bright winter Saturday, while out to lunch with friends (this was in the pre-Covid era, when you could actually do such frivolous things as eating indoors, in person, with people who don’t happen to live with you), she got that familiar feeling in her pelvis, excused herself for a quick trip to the bathroom, and discovered that she was bleeding. Fighting her rising panic, because like nearly every other woman in similar circumstances, she assumed it was “the Big C,” she picked at her food, made distracted conversation, excused herself as soon as socially acceptable to do so, and spent the rest of the weekend counting the minutes until she could come in to see me.
Recognizing that post-menopausal bleeding produces major anxiety, my staff worked Jane into the schedule right away. Following her exam, which confirmed the presence of blood, but not much else, we reviewed the various diagnostic pathways available to complete her evaluation, along with their pros and cons, and possible outcomes. She asked thoughtful, knowledgeable questions, voiced good understanding, and then she said, “let’s go with what you think is best, I trust you.”
Trust is the very foundation of any successful relationship. Without trust, we may assume that every purported run to the grocery store by our significant other is an illicit rendezvous with their secret lover. Without trust, when our elderly parents can no longer manage their finances, they may worry that we, their children, are draining their savings to enrich ourselves. Without trust, our children cannot learn to ride a bike, ice skate, or climb a jungle gym, knowing that we are close by to catch their fall. We must trust that our business partners, our families, our clients, our friends will behave honorably, that they will have our best interests at heart, that they will care as much, if not more, for us as for themselves. Trust allows us to feel safe and secure, to go confidently into the world, to conquer our fears, to achieve.
What happens when trust is absent or lost? Examples are not hard to find. We have been betrayed by police, who have an ethical and sworn duty to protect us, when they harm instead of rendering aid, when they close rank and the investigative review of their actions is hidden from the public, when their behavior violates equality under the law. We have been, and continue to be, harmed by politicians who value maintaining their power and the power of their party at the expense of the people they represent. Megadonor campaign contributions incentivize passage or maintenance of legislation which is contrary to the best interests of their constituents (see Big Pharma keeping drug prices so high that access is precluded; the NRA fighting sensible gun reform laws favored by the majority of non-gun owners and gun owners alike; private health insurance companies who maintain their profits and multimillion dollar executive salaries/stock option packages while charging their insureds a fortune in premiums, copays and deductibles; the tobacco industry killing 480,000 Americans per year). Congressional budgets cut funding for public health, prohibit government sponsored research on gun violence, and place such unreasonable restrictions on Title X funding that health clinics serving economically disadvantaged populations have no choice but to forfeit necessary money. The politicians have also squandered our trust with their repeated lies, innuendos, and distortions, by discouraging legitimate discourse, fostering hate, and further deepening the public divide.
Trust enabled Jane to navigate an unwelcome journey with courage and success. Trust made her calm, held her hand. Trust made the the frightening tolerable, the unbearable bearable. It is incumbent on those in power, whether it is a doctor in a patient-physician relationship, an elected official, a large employer, or a federal agency, to behave in an honorable and benevolent fashion and we must demand that they do so. If they do not deserve our trust, we must identify and elevate those who do instead. We live in a free democracy. We have the right to vote-with our patronage, with our support, with our ballots. We need trust to build the future we want, the future we deserve. We need trust in order to live.
*Clinically, Jane reflects many of my patients over the years. I am humbled and honored to note that her expression of trust does as well.