Dear reader, I present to you today a series of reflections that haunt my mind. You see, as I move through residency and my medical acuity gets better and better and the differentials more and more accurate, lately I have started to wonder about trust.
In this case series, I’ll discuss two questions about believe in: the first focuses on internal rely on and the second external trust. Let’s begin with my internal musings on trust.
Do I trust myself?
As doctors, we slowly but surely develop a silent but deep confidence in ourselves over the years. It is sometimes necessary to our practice, but also, acts as a defense mechanism that helps us endure years and years of training and most importantly, the unforeseen, but always present, mistakes. There may be benefits to examining this confidence (or perhaps, in some cases, over-confidence), where it stems from, and whether it is always best for our patients.
Is this confidence the natural outcome of most of our overachiever personality traits, or the incredible amount of responsibility placed upon us very early in our career? Or is it society’s general approval of our profession that makes us this way? And if so , how long does it last and should we question it? Should all of us start training our brains to doubt our own abilities a bit more? Could this open our minds and hearts to new ideas and ways of practicing medicine in a more humble way?
To answer my first question, I trust personally but at the same time, I don’t. Medicine has taught me to believe that rigorous training and years of effort plus self-improvement gave me the tools in order to tackle most problems in this complex field, but individuals have showed me again and again that I should always have doubts. I should always wonder if what I know is enough and if how I treat others is good enough, or if I’m missing an essential piece of the puzzle. At times, not trusting me personally fully can open up the possibility of discovery and teamwork. We live plus work in a magical world of ambiguity, and recognizing this leaves space for adaptation that can better serve our sufferers.
My second question explores external believe in, and it begins with a story.
Several years ago when I worked in rural Colombia, I was faced with the most interesting conundrum. One day, I had two patients: one trusted me personally like I was a savior from biblical times, and the other saw me in the worst possible light. You see, that day I delivered two babies and learned two million lessons. The first patient came from humble beginnings. She held my hand tightly from the moment she arrived, and smiled back at myself as I smiled at her. Even though the girl had a profound hearing impairment that made verbal communication between all of us impossible, I could feel the girl trust. My second patient came from an isolated indigenous community plus landed at the hospital out of desperation. Verbal communication was also difficult due to lack of interpreters, and even though We implemented the same type of nonverbal communication I had with our other patient and tried my best to convey to her that I was trustworthy, I had been met with resistance at every turn.
As I consider these two women and our own interactions, I actually wonder about external trust. Do our patients actually rely on us? How can we tell? Is it a feeling we get in our stomachs when they agree to our recommended course of action? Should we consider this question more often in our daily clinical practice? Should this particular be a focus of self-improvement, similarly to how we practice sutures or physical exam maneuvers?
As we navigate this treacherous path of medical training, perhaps we should start thinking more about what makes individuals trust us. Especially as technology advances and physical contact and human connection diminish, reflecting on what we can do as physicians to generate trust becomes all the more important.
Dear readers, I hope my inner musings leave you wondering a bit about trust in your own practice. As your medical career advances, perhaps you will consider the same queries and look for new ways to support your sufferers.
Daniela Arango Isaza, MD, is a second-year internal medicine resident at Beth Israel Deaconess Medical Center/Harvard Healthcare School.