Hastings Cent Rep. 2020 Jan;50(1):18-26. doi: 10.1002/hast.1080.
There is ample evidence that patient mistrust toward the American medical system is to some extent associated with communal and individual experiences of racism. For groups who have faced exploitation and discrimination at the hands of physicians, the medical profession, and medical institutions, trust is a tall order and, in many cases, would be naive. Nevertheless, trust is often regarded as a central feature of the physician-patient relationship. In this article, I draw on empirical research, ethical theory, and clinical cases to propose one way that providers might address and, ideally, resolve mistrust when it arises in an immediate case. I describe how medical mistrust has been characterized empirically within medical and bioethics scholarship, and I provide an overview of theories of trust, arguing that they may be unable to account for the risks that providers must take in seeking to establish trust within many American medical institutions. Common assumptions in medical and bioethical scholarship on trust notwithstanding, caring and competence are not always enough to establish a trusting relationship between physician and patient. I suggest that, in an atmosphere of mistrust, comprehension of the existence and source of suspicion is essential to effective signaling of trustworthiness.
有充分的证据表明，患者对美国医疗系统的不信任在某种程度上与种族主义的集体和个人经历有关。对于那些曾在医生、医疗行业和医疗机构手中遭受剥削和歧视的群体来说，信任是很难建立的，在许多情况下，这是幼稚的想法。然而，信任通常被视为医患关系的核心特征。在本文中，我借鉴实证研究、伦理理论和临床案例，提出了一种提供者在即时案例中出现不信任时可以处理和理想解决不信任的方法。我描述了医学不信任在医学和生物伦理学术研究中是如何被描述的，并概述了信任理论，认为它们可能无法解释提供者在寻求建立许多美国医疗机构内的信任时所必须承担的风险。尽管医学和生物伦理学术中对信任存在一些共同的假设，但关怀和能力并不总是足以在医生和患者之间建立信任关系。我认为，在不信任的氛围中，理解怀疑的存在和来源对于有效地发出值得信任的信号至关重要。
