‘Right-touch’ trust: Thoughts on trust in healthcare

Trust is contextually charged. Like a play, it has ‘sets’ or ‘stages’ as well as ‘scripts’ and ‘actors’. It is predicated on the arena or conditions under which it takes place (Nooteboom 2002, Nooteboom 2006). The hazards of trusting vary not only in relation to the transactions involved, but also in relation to the environment within which they take place (Williamson 1993, 2006). In certain settings one is forced to trust blindly simply because the alternatives are worse (Gambetta 2000). In healthcare, the stakes are high, the power imbalances are substantial, and the risks are elevated, but alternatives are in short supply. Patients must take risks because other options are non-existent and the consequences of going without treatment are worse. Patients may exercise some influence over this but their ability to monitor or control professionals is substantially constrained by the trusting environment. The structure of care itself is imbued with a substantial power differential inherent in professionals’ body of clinical knowledge, experience in applying that knowledge, and position inside organizations, where the patient is but temporary. In such settings, risk is inevitable and vulnerability is inescapable.