The transformation of trust?: Exploring the utility of 'trust' as a social scientific concept
Clarissa Cook
University Department of Rural Health, University of Tasmania, Hobart, TAS
Abstract
If there's a single word that defines the doctor-patient relationship and must define it, the word is trust. Patients must trust their doctors, and in turn, doctors must trust their patients. I believe that this concept has eroded on both sides. (Krizek 1597: 1)
Few people would disagree with Krizek's statement regarding the importance of trust to the doctor-patient relationship. However, in order for this statement to be meaningful, the key word 'trust' must itself be defined.
Like so many other fundamental, taken-for-granted aspects of everyday life, trust is seldom analysed (Henslin 1981: 90). Although trust is a commonly used word, most people would probably be 'hard-pressed' to provide a definition of trust, at least without the aid of a dictionary! In everyday speech, the word 'trust' is used in different ways and to refer to different things. Similarly, sociological and other social-scientific discussions of trust are characterised by imprecision and ambiguity, which, although tolerable in everyday conversation, is unacceptable if 'trust' is to be employed as a concept with some theoretical utility.
This article develops some ideas about the concept of trust and its potential application to the sociological study of health and medicine. The focus here is on doctors, although it is acknowledged that trust is important for all health care workers. The article is divided into three sections. The first considers some of the ways in which doctors have themselves written about trust. Given doctors' apparent interest in the concept, the empirical investigation and/or theoretical development of trust by health/medical sociologists would seem to be a worthwhile enterprise. Some work has already proceeded in this direction, for example that undertaken by Lupton (1996) and Daniel (1994).
Trust is worthy of the attention of health/medical sociologists, not only because doctors appear to be concerned about it, but because trust relates to such topical and widely debated sociological issues as consumerism (and hence to debates on post-modernity) and knowledge/ communication in the context of the doctor-patient relationship. An improved understanding of the concept of trust gives a deeper theoretical understanding of these issues.
The second section of the article briefly explores the use of the concept within various social scientific fields, and compares it to the sociological literature on trust. Drawing upon the work of Lewis and Wiegert (1985a: 1985b), it outlines some requirements for a specifically sociological conception of trust, and emphasises the need to distinguish between different levels and dimensions of trust. Considerable clarification and refinement of this kind is required if 'trust' is to become a truly useful theoretical tool within the health social sciences, and the social sciences more generally.
The third and final section of the article answers two interrelated questions that arise from the preceding discussion - 'Is 'trust' useful for the sociological analysis of medicine?' and 'Is trust being transformed?' With respect to the analysis of medicine, it briefly considers some ways in which sociological insights regarding trust might be useful for investigating and theorising about a) the doctor-patient relationship, b) medical institutions and organisations and c) medicine as an 'expert system'. With respect to the transformation of trust, it addresses debates concerning the changing nature of trust and links these to debates about 'the rise of consumerism' in health care and the nature of 'lay' and 'medical' knowledge.
The conclusion returns to the issues raised in the introduction. It argues that theorising about trust is not 'armchair theorising' that is devoid of practical benefit. Rather, a highly developed 'sociology of trust' has the potential to deliver tangible benefits to sociologists. doctors and patients.
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