THE FUNCTIONS AND LIMITATIONS OF TRUST IN THE PROVISION OF MEDICAL-CARE

Trust, the expectation that institutions and professionals will act in one's interests, contributes to the effectiveness of medical care. Wi th the rapid privatization of medical care and the growth of managed c are, trust may be diminished. Five important aspects of trust are exam ined: technical and interpersonal competence, physician agency, physic ian control, confidentiality, and open communication and disclosure. I n each case, changing health care arrangements increase the risks of t rusting and encourage regulatory interventions that substitute for som e aspects of trust. With the increased size and centralization of heal th care plans, inevitable errors are attributed to health plans rather than to failures of individual judgment. Such generalized criticisms exacerbate distrust and encourage micromanagement of medical care proc esses.