Module 5: Trust
“A trusting relationship between provider and patient can have a direct therapeutic effect.(1) It also heightens the quality of their interaction, facilitates disclosure by the patient, enables the provider to encourage necessary behavioural changes and may permit the patient greater autonomy in decision-making about treatment.”(2)
As we have established, for various reasons, community members may have an inherent distrust of the medical system or its agents (doctors, volunteers, etc.). Minority groups have been historically discriminated against in the healthcare system, as have immigrant groups and the poor.(3) In addition to well-documented cases in which trust has been damaged, public trust in the health care system generally has declined over the past few decades.(4)(5)
Even for those who do not have a fundamental distrust of the medical system, the process of coming to trust a given institution or individual is certainly not instantaneous. Community clinics and volunteers need to work hard in order to foster trust between them and the population they serve. Gilson’s review of behavioral and psychological research suggests that building this kind of trust, specifically for healthcare providers, requires:
- Personal behaviors between patients and providers that build inter-personal trust
- Competence on the part of the care providers and on the part of the patients
- Organizational policies and practices that provide spaces for caring, engagement, open dialogue, and inter-personal interactions
- Political or organizational processes that protect the poorest and most vulnerable of groups
- The promotion of fairness and legitimacy as the roots of the policy-making decision process(6)
Volunteers are most concerned with the first three of these ways of building trust because they are the most easily affected from a volunteer’s position. In your everyday interactions with community members, it is important that you be courteous, respectful, and trustworthy. Community members will be far more likely to seek follow-up care and listen to the suggestions of volunteers if they have formed some kind of trusting relationship with the volunteers.(7)
Traits of a Trustworthy Volunteer
- Openness: Openness is the first step on the path to respect. When patients have different views of medicine, illness, and wellness than you do, you must keep an open mind in order to help them most effectively. They will also be more willing to trust you if you demonstrate that you are genuinely interested in (and open to) their worldview. By being open-minded you can do your best to bridge the gap between your opinions and theirs in a respectful manner.
- Dependability: Trust is not given freely or blindly. As a volunteer, you must earn trust by demonstrating your capacity and willingness to work hard and to follow through on promises. This means being punctual, professional, and consistent. Nobody trusts a “flaky” person who backs out of commitments or simply does not show up.
- Enthusiasm: Your presence and attitude while you are interacting with community members is very important. Although your volunteering may only be a few hours out of your week (and one of many things you do each week), it is highly impactful on the community members you interact with. You may be one of a mere handful of people connected to the health care community that they interact with on a regular basis. Because of this limited exposure, your attitude and energy will have a larger impact than you think. It is much easier to build a trusting relationship with someone if you demonstrate that you are genuinely concerned about their health and wellness.
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Footnotes
(1)Mechanic, D. (1998). Public trust and initiatives for new health care partnerships. The Milbank Quarterly76 (2), pp 218-302.
(2) Gilson, L. (2003) Trust and the development of health care as a social instutition. Social Science and Medicine, 56 (7): 1453-1468.
(3) Boulware, L. et. al. (2003) Race and Trust in the Health Care System. Public Health Reports, 118 (4): 358-365
(4) Welsh, T. and Pringle, M. (2003) Social capital: Trusts need to recreate trust. British Medical Journal, 323: 177-178.
(5) Davies, H. (1999) Falling public trust in health services: Implications for accountability. Journal of Health Services Research and Policy4(4): 193-194.
(6) Gilson, L. (2003) Trust and the development of health care as a social instutition. Social Science and Medicine, 56 (7): 1453-1468.
(7) Perry, H. et. al. (1999) Attaining health for all through community partnership: Principles of the census-based, impact-oriented (CBIO) approach to primary health care developed in Bolivia, South America. Social Science and Medicine, 48 (8): 1053–1068.