Transcending the Profession: Psychiatric Patients' Experiences of Trust in Clinicians

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 as well as fundamental changes to the nature of professionalism. To probe the relationship between professionalism and trust today, we analyzed interviews with 50 psychiatric patients receiving care in diverse clinical settings. We found patients experience trust when they perceive clinicians transcending the formal bounds of professionalism. Patients find clinicians to be trustworthy when clinicians pursue connections to their patients beyond organizational strictures, cross boundaries of professional jurisdiction to provide holistic care, and embrace the limits of their professional knowledge. This dynamic of trust in professionals who transcend the profession highlights novel dimensions of contemporary professionalism, and it makes sense of a seeming contradiction in which patients have high trust in individual clinicians but low trust in institutions.