Trust. Annual oration: Royal Victoria Hospital, Belfast, 3rd October 2002.

DPByrnes Not so very long ago a solitary skier was making his rapid way down a lonely mountain when he miscalculated and launched himself over a precipice. He was falling to what he thought was certain death when he managed to grab the proverbial small bush projecting from the cliff face. He hung in abject terror for some moments and then began to call out for help. "Is anyone out there?" he cried. This he repeated several times when to his great relief a deep and authoritative voice seemed to boom from a great distance. "My son if you have trust in me, let go of the branch". There was silence for a few moments upon which the skier, in a more plaintive voice croaked "Is there anyone else out there?" Trust in the sense of belief or reliance on others is, I submit, a complex and perhaps fragile commodity which we doctors may sometimes take for granted in our patients and their families. It is relatively easy to define in the dictionary sense but not, I believe, in the context of the doctor/patient relationship. We speak of belief in another, sincerity, compassion, honesty, competence. We also consider trust as a group of persons administering a fund or a property for the benefit of others, such as the Royal Group of Hospitals Trust. More of that later. Human beings are naturally inclined to trust others. On frequent occasions however we have little choice in the matter. As we sit in seat lID on an Airbus 321 about to take off, our imposed trust in the pilot is mixed with a degree of hope. We certainly have no say as to how many degrees of flap he deploys for the takeoff or whether he has checked the engine exhaust gas temperatures. We cannot even see if the runway is clear. Is our patient's trust in us the childhood or the air passenger variety? Is it natural, ie. instinctive, or imposed, i.e. the patient has little choice? Hippocrates who lived from approximately 460 to 377 BC in Greece was perhaps the first to consider and write about a doctor's duty. Essentially he wrote and presumably taught on how one should earn and maintain a patient's trust. It is interesting to speculate on why he felt it was necessary to write the eponymous oath. Could it be that he witnessed quacks and frauds …