FEATURE
TRUST AUTHOR Susan Bornstein , MD
I
think that the highest compliment a patient has ever paid me was , “ I trust you .” Jane * is 54 years old and stopped having periods seven to eight years ago . She ’ d always had terrible cramps and couldn ’ t wait to be done with them . On an unseasonably warm and bright winter Saturday , while out to lunch with friends ( this was in the pre-COVID-19 era , when you could actually do such frivolous things as eating indoors , in person , with people who don ’ t live with you ), she got that familiar feeling in her pelvis , excused herself for a quick trip to the bathroom , and discovered that she was bleeding . Fighting her rising panic , because like nearly every other woman in similar circumstances , she assumed it was “ the Big C ,” she picked at her food . She managed distracted conversation , excused herself as soon as socially acceptable , and spent the rest of the weekend counting the minutes until she could come to see me .
Recognizing that post-menopausal bleeding produces major anxiety , my staff worked Jane into the schedule right away . Following her exam , which confirmed the presence of blood , but not much else , we reviewed the various diagnostic pathways available to complete her evaluation , along with their pros and cons , and possible outcomes . She asked thoughtful , knowledgeable questions , voiced good understanding , and then she said , “ Let ’ s go with what you think is best , I trust you .”
Trust is the foundation of any successful relationship . Without trust , we may assume that our significant other ’ s “ run to the grocery store ” is a rendezvous with a secret lover . Without trust , when our elderly parents can no longer manage their finances , they may worry that we children are draining their savings to enrich ourselves . Without trust , our children cannot learn to ride a bike , ice skate or climb a jungle gym , knowing that we are close by to catch their fall . We must trust that our business partners , our families , our clients and our friends will behave honorably . We hope and trust that they will have our best interests at heart , and that they will care as much for us as we do for them . Trust allows us to feel safe and secure , to go confidently into the world , to conquer our fears and to achieve .
What happens when trust is absent or lost ? Examples are not hard to find . We have been betrayed by individual police officers , who have an ethical and sworn duty to protect us , when they harm instead of rendering aid . We feel our trust betrayed when they close ranks , and the investigative review of their actions is hidden from the public , and when their behavior violates equality under the law . We have been , and continue to be , harmed by politicians who value maintaining their power and the power of their party at the expense of the people they represent . Megadonor campaign contributions incentivize passage or maintenance of legislation which is contrary to the best interests of their constituents . There are so many examples . Big Pharma keeps drug prices so high that access is precluded . The National Rifle Association fights sensible gun reform laws favored by the majority of non-gun owners and gun owners alike . Private health insurance companies maintain their profits and multimillion-dollar executive salaries / stock option packages , while charging their insureds a fortune in premiums , copays and deductibles . The tobacco industry ’ s products are lethal to 480,000 American users per year . Congressional budgets cut funding for public health , prohibit government sponsored research on gun violence and place such unreasonable restrictions on Title X funding that health clinics serving economically disadvantaged populations have no choice but to forfeit necessary money . The politicians have also squandered our trust with their repeated lies , innuendos and distortions , by discouraging legitimate discourse , fostering hate and further deepening the public divide .
Trust is what enabled Jane to navigate an unwelcome journey with courage and success . Trust made her calm and held her hand . Trust made the frightening tolerable , the unbearable more bearable . It is incumbent on those in power , whether it is a doctor in a patient-physician relationship , an elected official , a large employer or a federal agency , to behave in an honorable and benevolent fashion . We must demand that they do so . If they do not deserve our trust , we must identify and elevate those who do instead . We live in a free democracy . We have the right to vote - with our patronage , with our vocal and financial support and with our ballots . We need trust to build the future we want , the future we deserve . We need trust
in order to live .
* Clinically , Jane reflects many of my patients over the years . I am humbled and honored to note that her expression of trust does as well .
A version of this article was previously published in Dr . Bornstein ’ s blog , which can be found at www . susanbornsteinmd . com .
Dr . Bornstein retired from her gynecologic practice to focus on health care delivery system advocacy and reform .
22 LOUISVILLE MEDICINE