Definitions
- “The trustworthy person is one who can be counted on, as a matter of the sort of person he or she is, to take care of those things that others entrust to one and whose ways of caring are neither excessive nor deficient.”
What is Trustworthiness?
- “Trustworthy individuals care about what other people value ‘at the right times, about the right things, toward the right people, for the right end, and in the right way.’”
- A trustworthy person must at all times act in a way that encourages trust.
- Three conditions for being trustworthy: must act within a persistent moral order, perform technical roles competently, and fulfill roles requiring a special concern for others.
- The one who places their trust is allowing themselves to be vulnerable
- Trust involves faith in the benevolence and good character of the one trusted.”
Why should we practice the virtue of Trustworthiness?
- Trust is necessary for the relationship between physician and patient.
- Trust in medicine has greatly declined in the U.S.
- Trust is shown to benefit the treatment process of the patient.
- There are multiple consequences of a lack of trust.
- A patient does not only trust a physician because of his skill, but because he believes the physician has goodwill toward the patient.
- The nature of the medical relationship means that the patient must submit himself to the doctor's care.
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
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.”
Discussion Questions
- Is the fourth-year student placing his trust in you? If he is, how so? Is making himself vulnerable and open to exploitation/betrayal? What is he expecting from you?
- Would talking to someone about what the fourth-year student said betray his trust?
- How might it “make things worse” if you talk to someone about what the fourth-year said? Could things get worse if you don’t talk to someone?
- What should you do if what you are trusted to do is not the best thing for the one who trusts you?
- Does the trust between fellow students mirror the trust between patient and physician? If it does, how so? If it does not, why not?
- How might one inspire trust to act in the best interests of another?
- How could one damage one’s own trustworthiness?
How do we foster Trustworthiness?
- To be trustworthy one must have fidelity, competence, honesty, confidentiality.
- Practical competence: you must have the ability to do what you are trusted to do well.
- Actively cultivate a love for the other – be it a patient, a friend, ect. – and a desire for their good.