Here, the authors present two justifications usually cited as sufficient to warrant patients‘ trust in physicians: professional status and individual merit. Whereas in ‘status trust’ professionalism is taken as a guarantor of trustworthiness, in ‘merit trust’ a physician’s trustworthiness is assessed individually. On either account, trust is justified by the physician’s professionalism. ‘Professionalism’ may be defined as ‘acting trustworthily’ in exchange for autonomy of decision-making, whereas trustworthiness refers to ‘competence’ in terms of episteme (theoretical knowledge), techne (craft or skill), and phronesis (practical knowledge or experience), and ‘commitment’ as ‘to act in a way that the truster approves’. The authors argue that although in principle trust in physicians is justified, since both professionalism and individually assessed trustworthiness grant derivative authority, the reality is different. because an increasing number of patients reject the concept of professionalism and, accordingly, find it difficult (or even impossible) to assess physicians’ trustworthiness. Hence, they no longer believe that their trust in physicians is justified.

So far, the authors have presented a maximally comprehensive definition of ‘trust’, i.e. a definition based on the full pattern. Such a definition is very narrow and arguably of limited use in everyday practice. However, through the pattern-based approach we are at liberty to use a less selective definition that covers only a number of the features of the pattern of trust depending on the situation. Thereby, one obtains a spectrum of definitions of ‘trust’, ranging from the basic definition based on the lowest common denominator of ‘trust’, ‘confidence’, and ‘reliance’, to the maximally comprehensive (i.e. very narrow) definition of ‘trust’. Whereas pattern-based definitions may not offer unequivocal definitions as necessary conditions-based definitions do, in compensation, they are much more flexible and can be adapted to different situations and different needs.

As it is unlikely to ever be a return to the sort of status trust possessed by the medical profession in previous years, the most likely means of re-establishing trust between physicians and patients will be through advancing merit trust. The authors argue that individual physicians have the best chances of gaining their patients’ trust by (1) practising genuine shared decision-making which involves an honest two-way knowledge transfer, (2) inviting the patient to share responsibility, and (3) admitting uncertainty (whether personal or inherent in the available information). Although there is no guarantee that these will be sufficient to restore trust in all cases, from reflecting upon the nature of both trust as a concept and the causes of the decline of trust, these all seem to be extremely important considerations for any attempt to do so. Medical institutions of any type will most likely find it harder to gain trust. For them, it might be best to grant individual physicians the freedom and scope to advance their own trustworthiness in the eyes of patients, allowing those patients with the ‘suspended’ form of mistrust to perceive the attempt at establishing trustworthiness.