• Ten characteristics of the untrustworthy

    For each of the following characteristics an individual exhibits, I lose a bit of trust in him/her:

    1. Never admits error
    2. Never acknowledges a good point even if (s)he disagrees
    3. Can’t acknowledge that even good ideas have limitations
    4. Doesn’t take criticism as an opportunity for improvement (overly defensive)
    5. Doesn’t adjust thinking in response to new (credible) information
    6. Thinks those with different views are stupid, evil, irrational, or corrupt
    7. Thinks politics drives all opinions
    8. Has no respect or need for the scientific process or results therefrom
    9. Doesn’t tweet
    10. Has no sense of humor (see 9)

    Most of these are matters of degree, even if I’ve written them as absolutes. Someone who admits error or acknowledges a good point once and never again doesn’t earn as much trust as someone who does so more routinely.

    Most of these are characteristics of children, or many children. I forgive the children.

    These (or their opposite, really) are hard to live by. Even those of us who value them don’t achieve perfection. That’s clear to others. If we’re honest, we’ll admit it to ourselves. Trying is important. It takes more than lip service. I guess the meta-point is that anyone who doesn’t believe that is the most untrustworthy of all.


    • A key item not listed:

      – Doesn’t acknowledge personal biases

    • For most there are no consequences to being wrong. Not so for Frakt and researchers like him, whose work is subject to peer review and who suffer the consequences of being wrong. I remember years ago when a well-known trial lawyer I know told me that there’s no such thing as bad publicity. Indeed, today I would argue that being wrong is a net positive for many. In my teens I faced hardships most don’t, and after achieving some success was often asked how I overcame the hardships. Fear, it’s the greatest motivator. Fear of poverty, fear of failure, fear of being wrong. Moral hazard has become the catch-phrase, yet for many who swear by it, few are affected by being wrong; for them, there are no consequences.

    • That sounds like a description of Jesus or St Paul.

    • Never trust a physician who doesn’t drink coffee (or another caffeinated product)

    • I was with you until 9. Can’t stand it. And, yes, I have a sense of humor. Just doesn’t come out in ultra short bursts.

    • Doesn’t tweet? Apparently, I don’t have a sense of humor either.

    • If you add Moses along with Jesus and St Paul it becomes the 10 Untrustworthy Commandments…

    • Robert F Hurley wrote a book published in 2012: “The Decision to Trust: How Leaders Create High-trust Organizations.” I would substitute the words “Primary Health Care” for “Organizations.” The book would then be a good starting point for building the character of uniformly available health care for anyone’s Basic Healthcare Needs.

      So then, how do we reform the healthcare industry so that uniformly available healthcare is equitably accessible and culturally acceptable to each citizen? And, with this in place, how do we sponsor the local initiative necessary to assure that this level of Primary Health Care exists for each citizen? With this strategy for healthcare reform, it would be possible to explore the strategies applicable for supporting a successfully evolving “high-trust” healthcare industry: community by community, one Primary Health Care clinic at a time. I suggest that the collective action requirements and the means for managing them are knowable. We simply lack the nationally supported “will” to build them. Highly trustworthy Primary Health Care that is focused on promoting Stable Health for each citizen will be the most successful strategy for improving our nation’s highly INEFFICIENT healthcare industry. Philosophically, it a voluntarism issue.

    • I worked for many medical maestros who generated an aura of absolute trust that shone through in their verbal and non-verbal communication to affect staff and patients at a subconscious level. It came from their deep selflessness. Their ego had been erased through a brutal process to leave only the essence of the medical ethic. They were subconsciously indoctrinated to never make a decision based on ego, defensiveness or personal interest. Cleansed of this, they knew that their objectivity in decision making was never corrupted and that became the core fo their self-confidence. They knew that they always went beyond the call of duty for the objective benefit of their patients without compromise.
      This was not just when they were face to face with the patient. It was in their spare time as a thirst for knowledge and self-improvement. Their lack of ego was the drive that made their constant search for self-betterment objective and effective.
      This is an increasingly difficult mindset to maintain as doctors are being culturally forced to act defensively and for patient popularity. They are forced into competitiveness and to fight for their rights in a world where lawyers, administrators, bean counters and politicians make decisions about medical practice not the most knowledgeable and ethical medical professionals.

    • There are people who claim that admitting any kind of error will be taken as weakness. Some even say that their position requires them to establish a kind of dominance, and that admitting error will make them less effective at their jobs. Some doctors and teachers might say those things.

      I think that world view is itself mostly self-serving and defensive, but it COULD be true. When people admit mistakes, I think all of us in the audience have to acknowledge that and publicly show respect for that act of courage. Maybe that will help create the perception that the world actually does reward honesty and humility.

      • Judging others on what you believe to be errors in medicine is a thorny subject. Outsiders tend to consider any negatve outcome to be an error but the vast majority of negative outcomes are the result of an appropriate risk benefit equation where the dice simply fell unfortunately. The second most common is that an appropriate decision was reached on the information gathered or available at the time but there was a problem with that information. True errors are rare.
        This is the finding of the institutionalised UK medical culture of multidsciplinary audit of every negative outcome in a ‘no blame culture’ as a communal learning experience to prevent errors from being repeated. To err once is human but to repeat an error through a lack of constructive self-criticism is negligent. However, what was found in practice is that most doctors blame themselves too much if they do not discuss their negative outcomes in a difficult and complex world of risk benefit analysis rather than black and white certainty.