Trust and the Profession: Experiences of Psychiatric Patients

• In Event: 3129 - Section on Medical Sociology Refereed Roundtables (1 hour)
  In Refereed Roundtable 60min: Table 6. Attitudes Toward Medical Professionals

Abstract

Classical medical sociological theory argues patients trust doctors in part because they are professionals. Yet in the past half-century medicine has seen a crisis of trust, particularly among patients with marginalized identities and stigmatized illnesses, as well as fundamental changes to the nature of professionalism. To probe the relationship between professionalism and trust for today’s patients, in this paper we analyze interviews with 50 psychiatric patients receiving care in diverse clinical settings. In contrast to the classical theory, we find patients experience trust when they perceive clinicians transcending the formal bounds of professionalism. We discuss three themes illustrating how clinicians appeared to “abandon the profession”: (1) Humane regard, when clinicians pursued connections to their patients beyond formal and organizational strictures; (2) structural competency, when clinicians crossed boundaries of professional jurisdiction to provide holistic care, sensitive to social determinants of their patients’ health; and (3) clinical humility, when clinicians embraced the limits of their professional knowledge. This dynamic of trust in professionals who go beyond the profession highlights where professionalism may have staying power, and it makes sense of a seeming contradiction in which patients have high trust in individual clinicians and low trust in institutions. Our findings suggest future study of professions must be attentive to how the daily interactions of professional practice are situated in institutional arrangements, as well as to how professionals can appear to break with the profession in order to signal trustworthiness.

Authors

• Mira Vale, University of Michigan

• Mary-Jo DelVecchio Good, Harvard University/ Harvard Medical School