Op-Med is a collection of original articles contributed by Doximity members.
We all know that trust is the currency for all effective relationships. It’s always been that way from the day that humans first set foot on the planet. Trust is why our hunter-gatherer ancestors created communities. Trust is why city walls were built—to allow those we trust inside and keep those we distrust outside. Trust is what powers the global economy. Trust also explains why some companies are more innovative and successful while others fail. Trust is the most powerful thing that exists within the doctor-patient relationship.
But how do we build, rebuild, and sustain trust?
For years now, I’ve been fascinated by the concept of trust, and have read and researched it extensively. My interest and passion come from my desire to connect better with people, helping them to develop and grow. And to be frank, I wasn’t very good at it when I started my research.
Here are 7 ways to build, rebuild, and sustain trust in your work relationships (i.e. patients, customers, coworkers) and your personal relationships (i.e. family, friends, strangers). As a physician, these steps personally help me cultivate trust with my patients and support staff, but they will work for anyone and any relationship.
Having the C.O.U.R.A.G.E to Trust
One of the best definitions of trust I’ve found comes from author Charles Feltman. He defines trust as choosing to risk making something you value vulnerable to another person’s actions.
When you look at that definition, you quickly see that trust is a choice. I wholeheartedly agree with that idea but will add that the choice is facilitated by a feeling — the feeling that you trust a person.
In his book The Thin Book of Trust, Feltman says, “When you trust someone, what you make vulnerable can range from concrete things such as money, a job, a promotion, or a particular goal, to less tangible things like a belief you hold, a cherished way of doing things, your ‘good name,’ or even your sense of happiness and well being. Whatever you choose to make vulnerable to the other’s actions, you do so because you believe their actions will support it or, at the very least, will not harm it.”
To trust is to be vulnerable. Trust is a choice you make to be vulnerable to betrayal, not in hopes of getting betrayed but in hopes of attaining a fuller and richer life in the process. And it takes tremendous courage to be vulnerable because when we trust, we give up control of something very valuable to us.
To help people remember these essential elements of trust, I have created a helpful acronym: C.O.U.R.A.G.E. It reminds us that it takes a lot of courage to trust someone, including the following:
Care and confidentiality
1. Care and Confidentiality
Of all the elements of trust, care is the foundation. Teddy Roosevelt once said, “Nobody cares how much you know until they know how much you care.” We are wired to trust people we perceive care for us and have our interests at heart. This is a protective mechanism that has served us well throughout human evolution.
How do you care for people? For the sake of brevity, I refer you to an article I’ve written titled “5 Traits of a Person Who Cares,” which serves as a good primer to start.
To that, I would add non-judgment and generosity. As author Brene Brown explains in her Braving the Wilderness, non-judgment means refraining from judging self or others. “I can ask for what I need, and you can ask for what you need. We can talk about how we feel without judgment.” Generosity means you extend “the most generous interpretation possible to the intentions, words, and actions of others”—in other words, you need to assume the best of others.
People will never open up enough to allow us to care for them if they don’t believe that we would keep their secrets confidential. They have to believe that when they open the door and let us into the darker and most vulnerable parts of their lives, we would protect that information and their honor. They have to know that information will be safe with us. If a person cannot trust you to keep their secret, they won’t share it with you. It’s that simple. Because of that, confidentiality is essential for effective care.
Open communication, radical transparency, setting clear expectations, and communicating them clearly are all essential elements of trust. Most of the time, the secrecy we maintain serves neither us nor those we are in a relationship with.
In the words of educator, author, businessman, and speaker Stephen Covey, seek first to understand, then to be understood. When you take the time to understand people, they feel safe to make themselves vulnerable to you because they believe that you understand them. A lot of times, we don’t trust how others will treat us and what we value not because we think they don’t care but because we think they haven’t taken the time to know us.
Be reliable. Make and keep commitments. Be dependable. Let your ‘yes’ be ‘yes’ and ‘no’ be ‘no’.
Give people as much autonomy as possible. We feel safe and can trust someone more when that person makes us feel that our autonomy is not threatened. We sense this when people honor our boundaries. At work, we sense this when leadership shows us that they trust us by giving us more autonomy and voice in how we do our work. Trust begets trust.
Be genuine. A genuine person is authentic, honest, truthful, and sincere in the way they live and in their relationships with other people. Genuineness is crucial to trust-building. Without genuineness, people just can’t trust you.
And, It’s not like genuine people are perfect. They are not. They make mistakes like everyone else. The difference is that when they make an error, they own up to it, apologize, and take responsibility to fix it.
Gain experience and competence in the area you want people to trust you in. If I wanted to have heart surgery, I would want an experienced and competent heart surgeon. Why? Because that’s who trust my heart with the most!
People trust us more when they are convinced we are competent in the area they need to trust us in as shown by past results and experience. As medical providers, we know this firsthand. People trust us with their lives every day because of the experience and competence we have acquired through medical school, residency, and board certification. Without such experience, no one should trust us with their health. Further, trust is usually specific, not general. (Just because I trust an experienced surgeon with my heart doesn’t mean I trust him to be my pilot!)
The lesson here is that if we want people to trust us in a specific area, we need to demonstrate competence to them in that area. If we don’t yet have that experience, we can diligently work to develop it and then help people perceive it.
I believe that as you do the things above, people will feel safe enough to trust you with things they value. Until we start doing these things that enable people to feel safe, they would not trust us, and they shouldn’t.
Dr. Kenneth Acha is a board-certified Family Medicine specialist and an assistant clinical professor of medicine who has been empowering people to contribute their greatest Life, Work, and Leadership to the world for more than a decade. You can follow him on his blog, KennethMD.com.
Dr. Acha is a 2018–2019 Doximity Author.