While we may attempt to re-establish our role as patient advocate as a resolution for the New Year, can this resolution be fully accomplished to the benefit of the patient when there are so many factors now in the medical care system that tend to counter the beneficial fruition of such advocacy? Though trust between the doctor and patient is an essential ingredient for a healthy doctor-patient relationship, does each party recognize that sometimes the breaking of trust is without intent but due to factors which are beyond individual control? Perhaps I am being too cynical but shouldn't both doctor and patient look to a more elementary behavioral change for relationship benefit as a resolution? ..Maurice.

With regard to unintentional break of mutual trust, there are exceptions to that trust that the opposite party might not anticipate. For example, the trust by the physician that the patient will be compliant taking his prescribed hypertension medication. The patient leaves the office will the full intent to comply but may find that the prescribed medication is too expensive for his finances, nevertheless purchases it but takes only half the daily dose to conserve. The intent was to follow what the patient was told by the doctor but circumstances led to non-compliance. On a return visit the patient's hypertension is not improved. With regard to the physician, the patient trusts that the doctor will perform the operation successfully without complication and yet that trust may be broken due to an unintentional complication during surgery. In each case, the trust was broken and yet would one want to call the doctor or the patient "unworthy" of the other's trust?
Not necessarily, unless the cutting back on the dose or the surgical complication was not reported to the other party. In that case, the implied trust of being open, revealing and honest with each other would have been broken. I am looking for a more basic behavior as a New Years resolution to improve the doctor-patient relationship. ..Maurice.

I don't mind belaboring since it emphasizes the writers view. But let's look at a more common behavior that is missing in many doctor-patient relationships and but when present is surely the basis for the development of trust between the parties. That behavior which may be missing to various degrees is adequate and appropriate communication between doctor and patient. That means that the doctor should take time to talk to the patient and take time to be attentive and listen to the patient. Yet, communication would be incomplete if the patient was reluctant to speak to the physician. Some patients fear to express to their doctor the concerns, issues and requests which they hold. Perhaps that reluctance is that the patient doesn't think that the doctor would find the expressions as important or perhaps the patient simply fears challenging the physician and not knowing and fearing how the doctor (who may hold the therapy for the patient's symptoms) might respond. From my point of view, better communication would be one resolution which would be critical for both the doctor and patient to strive for as they make their New Year resolutions. ..Maurice.

Art, you are absolutely correct that communication and trust are both essential to each other in a doctor-patient relationship. Do you think that trust begins even before communication, such as an assumption, occasionally erroneous, of trust based on the patient's understanding of medicine as a profession and the publicized criteria of such a profession and any recommendation that the patient received from other trusted friends about that physician? Do you think that from the physician's point of view about the unknown patient over the desk, the trust in the patient is based on the assumption, occasionally erroneous, that the patient will be cooperative and do everything possible to help the doctor make the diagnosis and to carry out the treatment? Why I think that communication is primary is that without additional communication by both parties, that initial trust may be degraded. Communication is the structural component that builds on this initial trust or if inadequate will lead to the trust's collapse. "I trust you understand." (oops..I didn't want to sound sarcastic but I thought I would throw that expression in as a conclusion to my discourse.) ..Maurice.