Developing, Losing, and Regaining Trust in the Doctor-Patient Relationship

Theodore A. Stern, MD^c; James K. Rustad, MD^a,b,‡; Steven C. Schlozman, MD^a,‡; Reuben A. Hendler, MD^c,‡; Matthew J. Rasmussen, MD^a,‡; Gerald L. Rader, III, MD^a,‡

Prim Care Companion CNS Disord 2022;24(3):21f03184

LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Free Access: Please Log In

This content is completely free—but you need to be logged in to read the full article. If you already have an account, please log in below. Otherwise, register for free to unlock instant access.

References (42)

Pearson SD, Raeke LH. Patients’ trust in physicians: many theories, few measures, and little data. J Gen Intern Med. 2000;15(7):509–513. PubMed CrossRef
Armstrong K, Rose A, Peters N, et al. Distrust of the health care system and self-reported health in the United States. J Gen Intern Med. 2006;21(4):292–297. PubMed CrossRef
Hermesh B, Rosenthal A, Davidovitch N. The cycle of distrust in health policy and behavior: lessons learned from the Negev Bedouin. PLoS One. 2020;15(8):e0237734. PubMed CrossRef
Petrocchi S, Iannello P, Lecciso F, et al. Interpersonal trust in doctor-patient relation: evidence from dyadic analysis and association with quality of dyadic communication. Soc Sci Med. 2019;235:112391. PubMed CrossRef
Cruess RL, Cruess SR. Expectations and obligations: professionalism and medicine’s social contract with society. Perspect Biol Med. 2008;51(4):579–598. PubMed CrossRef
Huynh HP, Dicke-Bohmann A. Humble doctors, healthy patients? exploring the relationships between clinician humility and patient satisfaction, trust, and health status. Patient Educ Couns. 2020;103(1):173–179. PubMed CrossRef
Iott BE, Campos-Castillo C, Anthony DL. Trust and privacy: how patient trust in providers is related to privacy behaviors and attitudes. AMIA Annu Symp Proc. 2020;2019:487–493. PubMed
Fricchione GL. Separation, Attachment, and Human Development. In: Fricchione GL, ed. Compassion and Healing in Medicine and Society: On the Nature and Use of Attachment Solutions to Separation Challenges. Baltimore, MD: The Johns Hopkins University Press; 2011: 207–224.
Bowlby J. The making and breaking of affectional bonds, I: aetiology and psychopathology in the light of attachment theory. an expanded version of the Fiftieth Maudsley Lecture, delivered before the Royal College of Psychiatrists, 19 November 1976. Br J Psychiatry. 1977;130(3):201–210. PubMed CrossRef
Bowlby J. The making and breaking of affectional bonds. II. Some principles of psychotherapy. the fiftieth Maudsley Lecture. Br J Psychiatry. 1977;130(5):421–431. PubMed CrossRef
Bowlby J. Developmental psychiatry comes of age. Am J Psychiatry. 1988;145(1):1–10. PubMed CrossRef
Fricchione GL. Separation, Attachment, and the Life Cycle. In: Fricchione GL, ed. Compassion and Healing in Medicine and Society: On the Nature and Use of Attachment Solutions to Separation Challenges. Baltimore, MD: The Johns Hopkins University Press; 2011:225–237.
Blatt SJ, Behrends RS. Internalization, separation-individuation, and the nature of therapeutic action. Int J Psychoanal. 1987;68(Pt 2):279–297. PubMed
Fricchione GL. Evolution of the Brain. In: Fricchione GL, ed. Compassion and Healing in Medicine and Society: On the Nature and Use of Attachment Solutions to Separation Challenges. Baltimore, MD: The Johns Hopkins University Press; 2011:109–143.
Gintis H, Bowles S, Boyd R, et al. Explaining altruistic behavior in humans. Evol Hum Behav. 2003;24(3):153–172. CrossRef
Damasio A. Human behavior: brain trust. Nature. 2005;435(7042):571–572. PubMed CrossRef
Kosfeld M, Heinrichs M, Zak PJ, et al. Oxytocin increases trust in humans. Nature. 2005;435(7042):673–676. PubMed CrossRef
Auchincloss EL, Weiss RW. Paranoid character and the intolerance of indifference. J Am Psychoanal Assoc. 1992;40(4):1013–1037. PubMed CrossRef
Blum HP. Object inconstancy and paranoid conspiracy. J Am Psychoanal Assoc. 1981;29(4):789–813. PubMed CrossRef
Gabbard GO. Cluster A Personality Disorders: Paranoid, Schizoid, and Schizotypal. In: Gabbard GO, ed. Psychodynamic Psychiatry in Clinical Practice. 4th ed. Washington DC: American Psychiatric Publishing Inc; 2005:401–426.
Shapiro D. Paranoid styles. In: Neurotic Styles. Basic Books. New York, New York;1965: 54–107.
Lewis JM. Repairing the bond in important relationships: a dynamic for personality maturation. Am J Psychiatry. 2000;157(9):1375–1378. PubMed CrossRef
Maier SF, Seligman MEP. Learned helplessness: theory and evidence. J Exp Psychol Gen. 1976;105(1):3–46. CrossRef
International Dual-Loyalty Working Group. Dual-Loyalty and Human Rights in Health Professional Practice: Proposed Guidelines and Institutional Mechanisms. In: Allhoff F, ed. Physicians at War: International Library of Ethics, Law, and the New. Vol. 41. Dordrecht, Netherlands: Springer; 2008:15–38.
Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212–1215. PubMed CrossRef
Kontos N. Ethics of Incongruity: moral tension generators in clinical medicine. J Med Ethics. 2019;45(4):244–248. PubMed CrossRef
Kelly JF, Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? a randomized study of two commonly used terms. Int J Drug Policy. 2010;21(3):202–207. PubMed CrossRef
Beach SR, Taylor JB, Kontos N. Teaching psychiatric trainees to “think dirty”: uncovering hidden motivations and deception. Psychosomatics. 2017;58(5):474–482. PubMed CrossRef
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA: 2013.
Palmieri JJ, Stern TA. Lies in the doctor-patient relationship. Prim Care Companion J Clin Psychiatry. 2009;11(4):163–168. PubMed CrossRef
Hills L. What to do when trust has been breached in your practice. J Med Pract Manage. 2013;29(3):199–203. PubMed
Reyre A, Jeannin R, Larguèche M, et al. Care and prejudice: moving beyond mistrust in the care relationship with addicted patients. Med Health Care Philos. 2014;17(2):183–190. PubMed CrossRef
Stephens AL, Bruce CR, Childress A, et al. Why families get angry: practical strategies for clinical ethics consultants to rebuild trust between angry families and clinicians in the critical care environment. HEC Forum. 2019;31(3):201–217. PubMed CrossRef
Dudzinski DM, Alvarez C. Repairing “difficult” patient-clinician relationships. AMA J Ethics. 2017;19(4):364–368. PubMed CrossRef
Buchman DZ, Ho A. What’s trust got to do with it? revisiting opioid contracts. J Med Ethics. 2014;40(10):673–677. PubMed CrossRef
Miller J. The other side of trust in health care: prescribing drugs with the potential for abuse. Bioethics. 2007;21(1):51–60. PubMed CrossRef
Cabaniss DL, Cherry S, Douglas C, et al. Psychodynamic Psychotherapy: A Clinical Manual. West Sussex, UK: John Wiley & Sons; 2017:94–100.
Trust, But Verify. Wikipedia website. Accessed October 27, 2021. https://en.wikipedia.org/wiki/Trust,_but_verify#
Ti L, Voon P, Dobrer S, et al. Denial of pain medication by health care providers predicts in-hospital illicit drug use among individuals who use illicit drugs. Pain Res Manag. 2015;20(2):84–88. PubMed CrossRef
Parmar GS, Hayashi K, Nolan S, et al. Non-medical prescription opioid use and in-hospital illicit drug use among people who use drugs. Drug Alcohol Rev. 2021;40(6):959–963. PubMed CrossRef
Strike C, Robinson S, Guta A, et al. Illicit drug use while admitted to hospital: patient and health care provider perspectives. PLoS One. 2020;15(3):e0229713. PubMed CrossRef
Lane H, Sarkies M, Martin J, et al. Equity in healthcare resource allocation decision making: a systematic review. Soc Sci Med. 2017;175:11–27. PubMed CrossRef