Have a little faith in me.
– John Hiatt
Spring ushers in major holidays in many faiths and religions. The rites of spring and the vernal equinox, new life and rebirth are springtime themes and touchstones across many cultures. Faith is important to many people and across many cultures and religions. I would assert faith is even important to atheists and agnostics, and those without a formal religious tradition.
Faith is important in medicine, too. For in medicine, we treat people, and understanding people and the influences of the greater culture and society — and faith and religion — is an important part of that understanding and the expectations and goals of care.
In considering faith and its role in medicine, it is also useful to think about it beyond the constraints of formal ritual and organized religion. In fact, faith itself operates distinctly, even independent of religion, although religion provides framework and structure, tradition and ritual for that faith.
In its most basic sense, faith is a kind of trust, whether in a being or entity beyond human experience, or faith in people, in the tangible, even in processes and procedures, institutions, history and tradition. Faith is based on trust; it is a kind of trust that bridges from the known to the unknown, from knowledge and understanding to the uncertain and unknown and poorly understood.
As physicians, we ask our patients to trust us, as we trust them too. This trust is built on a foundation of communication, and on the relationship that grows out of the trust and communication. But in fact we are also asking for their faith — in us, and in the treatments and procedures, the advice and recommendations, the systems and institutions that are a part of modern medicine. The faith is necessary, for no matter how much we inform and explain, we possess a special set of knowledge and skills that has taken many years to acquire, and continues to expand and evolve.
The patient must trust us, trust our knowledge and skills, and have faith.
Trust and faith are essential for a functioning physician-patient relationship. They are not amenable to quantification and measurement, and I don’t think they can be tested with randomized prospective studies or meta-analysis. But each of us physicians have witnessed the importance of attitude and confidence in the treatment and the plan, and the physician. This is faith.
We see the consequences when faith breaks down, when trust is broken. Is patient compliance affected? Are there more checks and balances, forms and oversight, checklists and measures? Certainly our systems and processes, treatments and techniques need testing and monitoring to improve and refine. But not all of these monitoring schemes are aimed at process improvement or optimizing patient care. It is a fine line, and a slippery slope when trust is lost, or faith broken.
Faith is based on trust. In medicine is based on communication, and ultimately on the physician-patient relationship. This relationship and its unique intimacy are what make the interaction between physician and patient so very different from the provider-client construct of business and commerce. So let Spring and the holidays remind us, give us strength and resolve in our efforts to protect and preserve the physician-patient relationship. Let us not forget this trust as we honor this relationship, and remember to keep the faith.
Kathryn A. Hughes is a general surgeon who blogs at Behind the Mask.
