Build trust by opening up. (Guest Editorial).

Trust is the glue that binds physician to patient and patient to physician. Having a trusting relationship is critical in a physician's ability to dispense good medical care. It is also a way to minimize malpractice claims.

At a time when the technologic element of medicine is ever increasing, when human touch is often replaced by machines and drugs, it is imperative for physicians to achieve and maintain a patient's trust. High tech demands more touch, not less. In a world where the house-calling family doctor no longer exists, it is critical for physicians to strive for this feeling of trust.

Communication and trust are closely intertwined. Medicine is in a crisis, and we need to address the issue of using communication to build trust.

The First Professionals Insurance Company recently noted that 82% of people who sue physicians cite communication issues as a major factor. Of this 82%, about a third of patients said that they perceived a lack of concern on the part of the doctor who they sued, and another third high-lighted a failure on the part of the physician to communicate.

An analysis of medical complaints by patients that was published in the Journal of the American Medical Association (287[22]:2951-57, 2002) reported that most patients who seek malpractice lawyers are motivated by perceptions of problems rather than by medical facts. The investigators concluded that it was an inability of physicians to establish a rapport with their patients that was the primary cause of the increased risk of malpractice claims.

How do physicians build trust? Trust is not easily achieved and usually must be earned over a considerable period of time. Once, a white coat and a stethoscope around a physician's neck brought instant trust and instilled instant confidence. Those days are gone. "Trust me, I'm a doctor, does not work as well as it once did.

When a patient knows a little about his or her doctor, it allows for an increased sense of closeness; caring; and, eventually, trust. Doctor and patient communication must flow both ways so that patients can begin to feel as if they understand and better know their doctor.