“Building a foundation of trust”

Message from the Editor—Building a foundation of trust Trust is one of the most important components of an intact care provider-patient relationship. Of the many issues brought to the forefront by global changes affecting health care delivery, the erosion of trust between patient and physician has been identified as one of the most serious developments as it affects the core of care delivery. In his book, " On the Take " written in 2005, Dr Jerome Kassirer identified several possible causes for this loss of trust between patients and physicians, such as commercial-ization of medicine, increased reliance on technology and excessive sub-specialization, while absconding general responsibility for the patient as a whole [1]. In the lead article of a recent Focus Issue in Spine © titled, " Do No Harm: The Balance of 'Beneficence' and 'Non-Maleficence' " , Dr Gunnar Anderson and co-authors identified the subject of complications and a lack of clear and effective communication from medical providers with their patients as a major foundational aspect in the erosion of trust [2]. They suggested a renewed dedication to straightforward reporting on complications from physicians in research reporting, as well as patient disclosures as an important step in reestablishing trust, by following the ancient wisdom, " Honesty is the primary foundation of trust in any relationship ". In the same Spine Focus Issue, Dr Mark Dekutoski et al identified a lack of readily available data on even common complications in spine surgery [3]. While this should not be used as an excuse for not disclosing potential complications in spine surgery to patients, it seems fair to demand an increasing effort from medical publications and educators to make readily available realistic data on complications. This would go a long way to serve as a platform for improved and clear physician-patient interactions and to create realistic expectations on results for patients, care providers, insurance carriers, and government agencies alike. It goes without saying that establishing realistic expectations—from complications to outcomes—is in everyone's best interest. In current practice, a commonly heard response to a patient question on outcomes may be, " There is a fifty 50% chance that this procedure will alleviate your pain ". While well intended and certainly not overly optimistic sounding, the factual basis for such a statement is often dubious and usually has been handed down from attending to resident for many years without really knowing if there is …