Abstract

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There are many definitions of trust but the most common identify trust as a way of bridging uncertainty in relationships, and involves the trustor having positive expectations, particularly about competence and the intentions of the trustee. Traditionally considered of extraordinary trustworthiness in terms of both competence and intent, certain sociological narratives have, however, for more than 20 years suggested that trust in the medical profession is in decline. The status of the profession in late modernity, an epoch characterised more generally by uncertainty and scepticism of expertise, came under threat following the emergence of various scandals, the proliferation of consumerism and marketisation in healthcare, and the de-privileging of biomedical knowledge. However, this narrative has been contested by various forms of empirical investigation which have suggested that though becoming more conditional, trust remains highly salient in the delivery of healthcare. More recently, however, significant populist social and political upheaval in the western world (most visibly Brexit in the UK and the election of President Trump in the US) have catapulted scepticism of and a narrative of a loss of trust in experts into uncharted territory. Whilst not overtly implicating medicine, considering the magnitude of these events and the emergence of an increasingly post-truth, post-expert world, it seems necessary for medical sociologists to renew interest in trust in medical knowledge and expertise. Consideration needs to be given to if and how this more general scepticism and distrust of expertise is evident in the context of contemporary medical practice. Indeed, in the current context of populist upheaval, is there something about healthcare that necessitates patient and public trust, and thus insulates it from scorn? Recent analysis of trust relations in the context of healthcare have clearly shown that it is important not just to focus on patient and public perspectives, but also focus on clinicians’ perspectives about trust with their patients, in colleagues, and trust in the system in which they operate. Comparatively neglected to date in the trust literature, this side of trust encompasses both interpersonal trust by professionals in patients and colleagues, but also ‘system trust’ in the sources of biomedical knowledge, such as the regulatory agencies and the drug industry. Indeed, due to the increasing complexity of biomedical knowledge, as well as the stratification of the profession and introduction of organisational contexts which are increasingly encroaching on the individual professional discretion of ‘rank and file’ clinicians, medical professionals are becoming more reliant on systemic agents to generate biomedical knowledge which they can rely on in their everyday practice.

The overall aim of this session is to encourage the submission of papers which explore the nature of trust relations from the perspectives of both patients, in a world increasingly sceptical of experts, and professionals, who increasingly practice in contexts of uncertainty and complexity. Against a setting of upheaval, does medical expertise remain insulated?

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Session organizer(s)

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Tom Douglass (UK) – is a Doctoral Researcher in Medical Sociology at the University of Kent. He is currently working on a research project in the sociology of pharmaceuticals implicating trust relations. He has recently written on the neglect of professional perspectives on trust: Trust Matters For Doctors? Towards An Agenda for Research (2016).

 

Michael Calnan (UK) – is a Professor of Medical Sociology. His interests include the study of trust relations in health and health care and relevant publications include:-Trust matters in healthcare (2008); Trusting on the Edge (2012) and The Erosion of Trust in the Medical Profession in India (2016).

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