By: Gersten Jonker, Vanessa Burch and Arvin Damodaran
As an anesthesiologist, I am frequently called upon to take an infant from the arms of vulnerable parents to a cold, sterile theatre for a procedure. Surrendering the child to my care is an act of trust on their part, which I deeply respect. I always try to slow down and gather myself before this engagement, aware that calmness, the tone of my voice, and giving my undivided attention to the task may foster parental trust. Perhaps this is the greatest act of trust human beings ever undertake: handing over the care of self or a sick loved one to a relative stranger, perhaps a nurse, anesthesiologist, surgeon, pediatrician, physician, etc.
While society has entrusted health care to those with this wide range of confusing designations, the question remains, “How do we, as individual human beings, make decisions about trusting healthcare professionals?”
Deciding to trust a healthcare professional is frequently done with very little helpful information. Regularly, as practitioners, we have not met the patient before, much less the inner circle of loved ones, when they must make a trust-based decision that we will provide the most appropriate health care with the patient’s best interests at heart. This highlights the extraordinary vulnerability of the patient and their carers – Do they decide to trust the person/people, the process(es), the system? Do they have any choice, and what are the implications if this is not the case? Patients and families may feel that the risks are heightened in emergency situations when care decisions are made without time to travel to a bigger center, explore all management options, or consult a more experienced practitioner. A decision needs to be made to trust. Or not.
So, how then do we make decisions about practitioner entrustment when we seek health care? To begin to answer this question, it is useful to look at some of the vast work that has been written about trust. More than 30 years ago, Mayer et al provided a compact framework in which the perception of trustworthiness is a factor which feeds into making a yes/no entrustment decision whenever we delegate a task (Mayer et al, 1995). In this formulation, trustworthiness has been boiled down to three irreducible elements: ability, benevolence, and integrity. It is interesting that this influential framework remains well aligned with more recent work showing that trustworthiness, as understood by practitioners training the health workforce, includes the key elements of agency, reliability, integrity, capability, and humility (Ten Cate & Chen, 2020). While the expectation of ability or capability is expectedly foundational to the concept of trust, integrity also plays a central role in this decision-making process. And then there is benevolence, the art of being kind. We, as healthcare professionals training the next generation, may be partly articulating this critical attribute in concepts such as patient-centered care.
But what is the opinion of the person on the street? Can we explore public opinion of trust in health care practitioners in a way that better answers the question? Despite there being a wealth written on the topic, a recent blog pointed out that public trust in healthcare continues to decline despite multiple health professions education initiatives to address the ‘soft’ skills of medicine, i.e., the art of medicine (Burch, 2025). So, being reflective practitioners, what may we conclude? Do we need to ask the question of different people, ask the question in different ways (Crossley & Jolly, 2012), or listen more carefully to the answers we obtain?
Trust is only required when there is personal risk (Damodaran et al, 2017); perhaps the key to unlocking trust is understanding vulnerability. Based on our experience as health care providers, we would like to propose that part of the answer may be more about being kind in moments of greatest vulnerability. Maybe patients and their loved ones will tell us that rapid entrustment decisions are based on simple elements of human behavior including voice tone, volume and pace, word choice, calmness, and providing our undivided attention during those critical, urgent conversations. Not in a performative way, but in a connected way with an understanding of human vulnerability. Whatever the answer, we need to pay close attention. As educators, we need to frame competency-based education (CBE) to better meet the expectations of society, whose trust in medical care continues to dwindle despite our best efforts.
How would you like a healthcare professional to ‘show up’ when you hand over the care of your sick loved one?
If you would like to contribute to this conversation with your own stories or ideas, please use the ‘Comment – add yours’ button below this blogpost or reach out to the authors at g.jonker-4@umcutrecht.nl. of life—and we would argue, certainly, for WBA as well.
Refrences:
- Burch V. The paradox of trust – Where there is smoke, there may be a fire, blogpost 2025. Accessible on: https://icenet.blog/2025/07/10/the-paradox-of-trust-where-there-is-smoke-there-may-be-a-fire/
- Crossley J & Jolly B. Making sense of work-based assessment: ask the right questions, in the right way, about the right things, of the right people. Medical Education, 2012; 46: 28-37.
- Damodaran A, Shulruf B, Jones P. Trust and risk: a model for medical education. Medical Education, 2017; 51: 892–902.
- Mayer RC, Davis JH, Schoorman FD. An Integrative Model of Organizational Trust. Academy of Management Review,1995; 20(7): 709-734.
- Ten Cate O & Chen C. The ingredients of a rich entrustment decision, Medical Teacher, 2020; 42(12):1413-1420.
About the Author:
Gersten Jonker, MD, PhD, is an anesthesiologist with a PhD in medical education. He is the program director of anesthesiology residency training at the University Medical Center Utrecht in the Netherlands. His research interests are competency-based workplace-learning and workplace-based assessment.
Vanessa Burch, MBBCh, MMed, PhD, is a rheumatologist and Honorary Professor of Medicine at the University of Cape Town where she was the Clinical Chair of Internal Medicine. Currently, she is Executive Director of Education and Assessment at the Colleges of Medicine of South Africa. She is part of a national steering committee responsible for the design and implementation of EPA-based and WBA-driven postgraduate medical education in South Africa.
Arvin Damodaran, BScMBBS, MMedEd, PhD, is a rheumatologist and medical educator based at Prince of Wales Hospital in Sydney, Australia. He is an Associate Professor and Head of Randwick Clinical Campus for the School of Clinical Medicine, UNSW Sydney. Arvin’s doctoral thesis explored ‘trust’ as experienced by clinical teachers, identifying how perceptions and risk influence task delegation decisions. His UNSW research profile can be found here.
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