Trust in trust

Ordering food at a restaurant, walking across a zebra crossing or sitting down in a dental chair and opening wide. For society to function we have to trust other people. Sometimes though relying on trust alone can get us in hot water with dentistry being no exception.

My curiosity on the topic took me to one of the authorities on the matter. Meeting maxillo-facial surgeon and ex-president of the Dental Board Rowan Story was an amazing experience. Rowan has pursued many ventures in his life, which has taken him to rare heights. A full list of his accomplishments can be found here.  

Rowan teaches ethics and law (yes, he's a lawyer too.) to dental students at Melbourne University. One of Rowan's key messages to budding dentists is to always honor the trust that patients will put in them. Patients put the longevity and health of their teeth in the hands of another and trusts.

After a 10 minute consultation, most patients will let a clinician drill into their tooth or cut into them with a scalpel. It's quite an amazing thing if you think about it.

Rowan's words resonated in my mind. My current involvement with CoTreat has led me to question abstract concepts like trust. The question compounded in my mind after speaking to Startmate CEO Michael Batko. In our short conversation, Michael  said he "trusts" his dentist, a statement that 79% of Australians agree with. Michael's sentiment bought me fear and curiosity. The problem of trust in health professionals is obvious to industry insiders but a deeply latent one for even the most sophisticated assessors of risk.  

I found some answers in Paul Slovic's much cited paper, The Risk Assessment Battlefield. In this paper, Slovic points out that trust is often used as a proxy for risk assessment. A patient in the dental chair is unable to assess their risk properly due to the large amount of asymmetry in knowledge between patient and dentist. This results in the patient instead using less than ideal, feeling based methods like trust.  

Trust can be hacked. Robert Cialdini (author of Influence and Pre-suasion) and Daniel Kahnemann (author of Thinking Fast and Slow) have demonstrated dozens of ways to hack trust. An aura of authority, the use modern equipment, a good reputation, a good dress sense and a friendly smile are among some of the various halo effects that can create trust without merit. This can sometimes lead to severe lapses in judgment by the patient.  

Trust can be hacked.

The patient is replacing a difficult question (is this treatment plan evidence based and indicated for me) with a much simpler one (does this dentist look confident, competent and trustworthy). The patient is hoping the ethics and morality of the clinician will lineup with their perception of them.

A simple and obvious way to ensure good outcomes is to seek second opinions wherever possible. Ethical clinicians will welcome second opinions and will data share willingly.