Marcus posted recently about trust.  I think he's talking about it in the context of the physician-patient relationship .. but maybe he's discussing it more globally.

The physician-patient relationship (or the physician-parent relationship) is very tricky .. to some degree because the physician may need to trust the patient much less than the patient needs to trust the physician.   Yet without risking anything, aren't we expecting too much of our patients to trust us .. if we don't invest some trust in them?

The EBM/Malpractice discussion that went on about a month ago seemed to focus on trust. 

  • Our trust in evidence-based medicine as a way to deliver good care.
  • Our patients' trust in their physicians.

The trouble is that the perceptions and expectations can become cloudy in the context of fear and insecurity. 

Reading Ross' discussion (1st link above) – he puts this very clearly:

How can they possibly determine how to conform to the "standard of care," when they could be dragged into a lawsuit for doing exactly what they've been trained to do? How can a doctor be doing the right thing by keeping up to date with his medical education and respectful of his patient's autonomy, and yet be found wrong by being too curent and not being directive enough?

No kidding.  By presenting choices to our patients, we risk providing a window into the true uncertanties of medicine (of which there are many!) In so doing, we are sharing decisions with them – and trusing them with this vulnerability.

I'm convinced it's better healthcare, but as my legal advisor reminds me, this decision entails risk.  So be it.  Paternalistic physicians who dictate the mythical "standard of care" to their patients are at less risk legally, yet the care they provide can hardly be fulfilling — or even challenging!