{"id":3567,"date":"2019-08-02T18:41:42","date_gmt":"2019-08-02T17:41:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3567"},"modified":"2019-08-02T18:44:30","modified_gmt":"2019-08-02T17:44:30","slug":"the-consequences-of-doctors-mistrust","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/","title":{"rendered":"The Consequences of Doctors\u2019 (Mis)trust"},"content":{"rendered":"

By Joshua Parker.<\/p>\n

Working as a junior doctor provides unique insights into other doctors\u2019 reasoning. Being inexperienced and perhaps a little unconfident means junior doctors rely on their seniors for advice. Often I will see a patient and hit a dead end in terms of what to do next. This is where I approach a senior and we will discuss what investigation or management is appropriate. Within this dialogue my senior will show their working which is immensely helpful for my understanding, learning and development. Yet, occasionally, the conversation about what I ought to do next is driven by reference to avoiding complaints or litigation. This type of practice is known as defensive medicine<\/a> and is disconcertingly common<\/a>. These kinds of interactions always left me wondering why some doctors make the care of their GMC number their first concern.<\/p>\n

Zo\u00eb Fritz and Richard Holton provide an answer<\/a> to the question of why doctors overuse treatments and investigations. Their contention is that it is to enhance trust. So, doctors aren\u2019t practicing defensively when they use treatments or investigations inappropriately; they are signalling that they are trustworthy and using this to build a relationship. Whilst this appears entirely plausible, it didn\u2019t match the reasoning my seniors were using. Reflecting on my own experiences \u2014 especially in areas like A&E where interactions are both brief and consequential \u2014 in spite of the merits of their account, it didn\u2019t tell the full story.<\/p>\n

Fritz and Holton focus largely on patients trusting doctors. Patients believe that doctors have their interests at heart and so grant doctors certain powers. In my response<\/a>, I considered what it would look like for doctors to trust their patients. What discretionary powers do doctors\u2019 trust grant patients? Could we explain doctors\u2019 defensive practice by reference to (mis)trust in their patients? If defensive practice strips patients of any power of recourse against a doctor then doctors have no need to trust their patients.<\/p>\n

Taking this idea of a link between doctors\u2019 trust and defensive practice further I also explored doctors trust in \u2018the system\u2019. Recent high-profile cases<\/a>, not to mention doctors\u2019 current working environment, have eroded doctors\u2019 trust in the system to keep them safe from complaints and litigation.The distrusting doctor\u2019s response to the system might be defensive practice, similarly to within the doctor-patient relationship. Assuming that defensive practice harms patients and that litigation is bad for doctors, doctors who don\u2019t trust the system to protect them are placed in the perverse situation of having to decide between their own professional interests and the patient\u2019s interests in avoiding defensive practice. Clearly this latter concern ought to be subject to further ethical analysis.<\/p>\n

Understanding the consequences of a lack of trust in healthcare is important for appreciating how doctors\u2019 practice is altered and the impact on patients. From here, solutions can be generated and hopefully practice improved. My hope is that my paper contributes to this end.<\/p>\n

 <\/p>\n

Paper title: Too much medicine: not enough trust? A response.<\/a><\/p>\n

 <\/p>\n

Author: Joshua Parker<\/p>\n

 <\/p>\n

Affiliations: Education and Research Centre, Wythenshawe Hospital, Wythenshawe, Manchester M23 9LT<\/p>\n

 <\/p>\n

Competing interests: None<\/p>\n

 <\/p>\n

Social media accounts of post author(s): @joshp_j<\/p>\n","protected":false},"excerpt":{"rendered":"

By Joshua Parker. Working as a junior doctor provides unique insights into other doctors\u2019 reasoning. Being inexperienced and perhaps a little unconfident means junior doctors rely on their seniors for advice. Often I will see a patient and hit a dead end in terms of what to do next. This is where I approach a […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2745,576],"tags":[],"class_list":["post-3567","post","type-post","status-publish","format-standard","hentry","category-professionalism","category-the-art-of-medicine"],"yoast_head":"\nThe Consequences of Doctors\u2019 (Mis)trust - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Consequences of Doctors\u2019 (Mis)trust - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Joshua Parker. Working as a junior doctor provides unique insights into other doctors\u2019 reasoning. Being inexperienced and perhaps a little unconfident means junior doctors rely on their seniors for advice. Often I will see a patient and hit a dead end in terms of what to do next. This is where I approach a [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2019-08-02T17:41:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-08-02T17:44:30+00:00\" \/>\n<meta name=\"author\" content=\"Hazem Zohny\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Hazem Zohny\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/\"},\"author\":{\"name\":\"Hazem Zohny\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/e73152f6aa4e164c7d625d77cf4fed35\"},\"headline\":\"The Consequences of Doctors\u2019 (Mis)trust\",\"datePublished\":\"2019-08-02T17:41:42+00:00\",\"dateModified\":\"2019-08-02T17:44:30+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/\"},\"wordCount\":540,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"Professionalism\",\"The Art of Medicine\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/\",\"name\":\"The Consequences of Doctors\u2019 (Mis)trust - Journal of Medical Ethics blog\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#website\"},\"datePublished\":\"2019-08-02T17:41:42+00:00\",\"dateModified\":\"2019-08-02T17:44:30+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/08\\\/02\\\/the-consequences-of-doctors-mistrust\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"The Consequences of Doctors\u2019 (Mis)trust\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\",\"name\":\"Journal of Medical Ethics blog\",\"description\":\"A blog to discuss the ethics of medicine in its many guises and formats.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\",\"name\":\"Journal of Medical Ethics blog\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2026\\\/04\\\/jme-logo.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2026\\\/04\\\/jme-logo.png\",\"width\":200,\"height\":50,\"caption\":\"Journal of Medical Ethics blog\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/e73152f6aa4e164c7d625d77cf4fed35\",\"name\":\"Hazem Zohny\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g\",\"caption\":\"Hazem Zohny\"},\"sameAs\":[\"https:\\\/\\\/www.practicalethics.ox.ac.uk\\\/people\\\/dr-hazem-zohny\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/author\\\/zohnyh\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"The Consequences of Doctors\u2019 (Mis)trust - Journal of Medical Ethics blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/","og_locale":"en_US","og_type":"article","og_title":"The Consequences of Doctors\u2019 (Mis)trust - Journal of Medical Ethics blog","og_description":"By Joshua Parker. Working as a junior doctor provides unique insights into other doctors\u2019 reasoning. Being inexperienced and perhaps a little unconfident means junior doctors rely on their seniors for advice. Often I will see a patient and hit a dead end in terms of what to do next. This is where I approach a [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/","og_site_name":"Journal of Medical Ethics blog","article_published_time":"2019-08-02T17:41:42+00:00","article_modified_time":"2019-08-02T17:44:30+00:00","author":"Hazem Zohny","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Hazem Zohny","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/"},"author":{"name":"Hazem Zohny","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/e73152f6aa4e164c7d625d77cf4fed35"},"headline":"The Consequences of Doctors\u2019 (Mis)trust","datePublished":"2019-08-02T17:41:42+00:00","dateModified":"2019-08-02T17:44:30+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/"},"wordCount":540,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"articleSection":["Professionalism","The Art of Medicine"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/","name":"The Consequences of Doctors\u2019 (Mis)trust - Journal of Medical Ethics blog","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#website"},"datePublished":"2019-08-02T17:41:42+00:00","dateModified":"2019-08-02T17:44:30+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/08\/02\/the-consequences-of-doctors-mistrust\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/medical-ethics\/"},{"@type":"ListItem","position":2,"name":"The Consequences of Doctors\u2019 (Mis)trust"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#website","url":"https:\/\/blogs.bmj.com\/medical-ethics\/","name":"Journal of Medical Ethics blog","description":"A blog to discuss the ethics of medicine in its many guises and formats.","publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/medical-ethics\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization","name":"Journal of Medical Ethics blog","url":"https:\/\/blogs.bmj.com\/medical-ethics\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2026\/04\/jme-logo.png","contentUrl":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2026\/04\/jme-logo.png","width":200,"height":50,"caption":"Journal of Medical Ethics blog"},"image":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/e73152f6aa4e164c7d625d77cf4fed35","name":"Hazem Zohny","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g","caption":"Hazem Zohny"},"sameAs":["https:\/\/www.practicalethics.ox.ac.uk\/people\/dr-hazem-zohny"],"url":"https:\/\/blogs.bmj.com\/medical-ethics\/author\/zohnyh\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts\/3567","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/users\/354"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/comments?post=3567"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts\/3567\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/media?parent=3567"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/categories?post=3567"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/tags?post=3567"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}