Trustworthiness

Definitions

1. Trustworthiness is the quality of being reliable, truthful, and deserving of confidence
2. Fidelity to commitments and consistency in word and deed
3. The virtue by which we prove ourselves worthy of others' trust

What is Trustworthiness?

Trustworthiness means being reliable, honest, and faithful to our commitments. In medicine, trustworthiness is essential to the doctor-patient relationship and the reputation of the profession. Patients must be able to trust that we will act in their best interest.

Why should we practice the virtue of Trustworthiness?

• Foundation of medicine: The entire medical enterprise depends on trust
• Patient vulnerability: Patients entrust us with their health, bodies, and deepest concerns
• Confidentiality: Patients must trust that their information will be protected
• Professional reputation: Trust in physicians benefits all who practice medicine

How do we foster Trustworthiness?

1. Keep your word: Follow through on commitments, large and small
2. Be honest: Tell the truth even when it's difficult
3. Maintain confidentiality: Protect patient information scrupulously
4. Show up consistently: Be reliable in your presence and attention
5. Acknowledge limits: Be honest about what you can and cannot do

Clinical Case

It’s the end of a long day on the wards. You are a third year medical student on the second week of your internal medicine clerkship. In the work room, another member of the team – a fourth year medical student who’s been doing his internal medicine subinternship for the past three weeks – is sitting at a computer in the work room. He looks exhausted. Casually, you ask “Hey, how’s it going?”

He looks up at you and – while making a gesture of pointing a gun to his head and pulling the trigger – says “Shoot me now.”

“What happened?” you ask.

“Let’s see. I looked like a fool on rounds today. Then that patient crumped and I had to be the one to tell the family he’d died. Let’s just say it didn’t go well. I’m really not sure that I have what it takes to be a doctor, but it seems too late to get out…”

You respond, “It was a bad day for me too – everyone has one of these every now and then.”

At this point, the senior and junior residents come in and start running the list of patients in preparation for sign-out. Your fellow student leaves the room before you can make sure he’s okay, but you think he’ll probably be fine. Once at home, however, you start feeling like something more might be going on with him. You remember he’s been quieter than usual and

wonder if you should talk to anyone about what he said. But, then, you think to yourself, “It was just a bad day; I don’t want to betray his trust and make things worse.”