Trust and Distrust

The conversation is not the same, not since the pandemic began.

But perhaps it changed a long time ago. We simply did not realize it.

The fundamental conversation between physician and patient in which the physician encourages, or convinces the patient to do something for the patient’s health has changed significantly.

Gone are the days when the paternalistic physician commands and the obedient patient obliges. Today the conversation is more of an awkward exchange between two individuals who are not quite sure of the other’s role – like an adolescent and a parent, or two drivers emerging from their respective cars after a minor collision – whatever the analogy, the change is apparent.

Overwhelmingly, patients do not like being told to get the vaccine. They do not like physicians touting the perceived medical benefits, nor do they like the shaming for refusing; but most of all, they do not like the one sided dialog in which a physician simply asserts his or her role as a physician, and therefore the sole authority in vaccine safety.

“I’m your physician, don’t you trust what I tell you?”

Most patients, even those willing to receive the vaccine, do not fully trust the vaccine. In fact, most have a healthy dose of distrust in the vaccine. While some have lower levels of distrust, and see the overall benefits in getting vaccinated in spite of the risks, others have high levels of distrust – high enough to overwhelm any perceived trust in their physicians or in healthcare at large.

To understand this, we must understand that trust is not the absent of distrust. The two do not vary inversely.

Rather, trust correlates with distrust through a series of convoluting factors that make the relationship between the two distinctly complex.

Patients can trust their physicians while distrusting their physicians’ advice. Just like parents can love their children even when a child is blatantly lying to her mother, with the mother knowing very well that what is being told is a lie.

Relationships are complex – not defined by any one action, statement, or belief.

And by imposing a supposed authority as physicians over patients, many physicians ascribe erroneously the patients’ trust with them to be the same as the patients’ trust in the vaccine.

But trust does not obey any properties of transference. In contrast with distrust, which rapidly transfers from physician to vaccine and vaccine to physician – in the minds of the patients.

A counterintuitive notion most do not discern.

Physicians believe the trust they have with their patients will engender trust in the vaccine – so they advocate for taking the vaccine.

Instead, the distrust patients have for the vaccine transfers over to the physician.

“Why is Dr. Johnson shaming me into taking the vaccine?”

“I already told Dr. Smith I am not comfortable getting it – it’s too new”

Distrust cannot be overcome with trust. It can only be overcome by validating the distrust and working to minimize the distrust – minimizing it to the point at which the distrust in the vaccine is less than the trust in the vaccine, prompting the patient to decide getting it makes sense.

Validating distrust requires physicians to indulge in the skepticism, the doubts the patient may have, no matter how incredulous or superstitious. After all, distrust is relative. Like beauty, its value is in the eye of the beholder.

And when physicians legitimize it, engaging in the patient’s distrust, a shift takes place. The trust between the patient and the physician overcomes the distrust between the patient and the vaccine.

Whereas before when physicians would discredit vaccine hesitancy in the patient, the distrust grew and permeated from the vaccine to the physician.

Discrediting distrust only causes it to grow. But acknowledging the distrust creates new opportunities to forge trust – extending beyond the physician and patient, cultivating trust between the patient and vaccine.

Most physicians believe intuitively that by leveraging trust they can address a patient’s distrust. But in fact the opposite is true.

Physicians should discuss why patients distrust the vaccine and work to address the lingering hesitancy. And by discussing it, legitimize those thoughts in the minds of patients, creating a path for patients to trust the vaccine.

Acknowledge the distrust and work through the skepticism to build trust.

Disregard the distrust and it overwhelms the trust.

Trust and distrust.

Forever linked, yet distinctly unique.

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