10 - Instrumental Utility of Trust

Summary

One of the starting assumptions of this book is that the decline of trust in medicine is a negative development and a reason for concern. This claim is only tenable if it can be demonstrated that trust has an intrinsic value. Despite the fact that there is no convincing empirical evidence for the usefulness of trust in the sense of a positive patient welfare outcome, the authors claim that trust has an instrumental value: (1) because it helps patients cope with uncertainty and risk and reduces the transaction costs caused by the inherent risk, (2) because it reduces uncertainty by inducing trustworthiness in physicians, and (3) because it reduces complexity. Moreover, because neither regulations and controls (which are often instituted to compensate for the decline of trust) nor contracts can compensate for the loss of trust or replace trust in the patient–physician relationship, trust is, in the final analysis, inevitable.