PI Brief Update

Why Trust is the Missing Piece of Healthcare - Dr Mark Burgin

10/12/25. Dr Mark Burgin uses his personal experience to explain why trust is the best predictor of excellent healthcare outcomes.

When I was a child I met a doctor who influenced my life, he stood at the end of my bed in the children’s ward in a suit with white coated doctors around him. Looking back now it is difficult to know what had the biggest impact on my 4-year-old mind. Was it his voice which was deep and comforting, or his charisma which was certainly impressive?

I knew immediately that I wanted to be a doctor and told my mother when she came to visit several hours later. I sat on my bed in the old Victorian ward in my PJs excitedly telling her about the best job in the world. Perhaps I was thinking about making people better but I suspect that it was the feeling that had changed my life.

I trusted that doctor in a way that I have not trusted any other person since. They appeared to be above any trivial issues, focused entirely on my health, on making me better. It is flattering to have this sort of attention and I was easily impressed. The experience taught me an important lesson about the power of trust.

Measuring trust

The NHS has recognised the importance of trust and there are various surveys on how trusted GPs and others are. The most famous survey is the friends and family test FFT which publishes monthly data. Although criticised methodologically the figures show for instance that A and E departments are the worst performing by a long way which aligns with information from other sources.

The changes in trust are more important than absolute vales and there have been worrying falls in trust in GPs. When asked about their choices people will say that they do trust the individual practitioners. They are concerned about difficulties with access to the GP and do not trust that someone will be there for them if they are ill.

The complexity of trust means that an overall figure does not do justice to the patient experience. I have recently sat for 14 hours in A and E in pain before finally being offered a painkiller (no longer necessary). The staff were highly professional and despite being busy took time to take a history, site a cannula and take bloods, just did not offer a painkiller.

Building trust

My trust in whether I would be offered prompt pain control was not improved by the above experience. I had tried a combination of the painkillers without benefit before I set off to the A and E department and my expectation was that I would be offered something stronger. Perhaps I had misunderstood what the word emergency means or they were suspicious of my intentions.

They finally offered IV morphine after 14 (very unpleasant) hours in the company of a hundred or so other patients. I declined the morphine but gratefully accepted the antinausea injection. There was no explanation for the delay, they did not suggest that they had made an error or that their hard-pressed doctor had been dealing with life-threatening illness and had not had time to deal with minor issues.

I understand that health systems will make mistakes and I do not criticise them for this. When they make a mistake they should admit this, try to put it right and learn from the experience. These simple steps would improve trust dramatically and likely reduce the number of mistakes that occur. The risk is that people like myself who have lost some trust will not attend appropriately in future causing increased costs and risks of a poor outcome.

Lost trust

Every doctor has met patients who have lost trust, they often present late with serious illness costing far more than other patients with the same illness. They often find it difficult to comply with treatments even if they are lifesaving. They suffer from acute anxiety when dealing with health care services making their behaviour challenging.

As a GP I was a magnet for what other doctors called ‘heartsink’ patients and but I could not understand the term. When I told my colleagues that I had never seen a ‘heartsink’ patient they were incredulous. We discussed the phenomenon and I explained that these people just needed to trust a doctor. Trust was the missing ingredient to solving their problems and when they gained it they got better.

Doctors make the worst patients and my low trust in surgery had led to me avoiding getting definitive treatment for my pain. When I finally accepted that I had been a ‘heartsink’ patient to my doctors I was referred to a surgeon. He was impressive and won my trust that I would be safe and have the best care.

Conclusions

I have read thousands of accounts of poor healthcare, of patients who have awful consequences and suffering. These would have provided a more compelling account of trust than my own experiences but miss a key point. If a 4-year-old child understands the importance of trust then it should not be overcomplicated.

I chose to describe my own rather ordinary experiences because they show the other side of trust. That simple steps can be highly effective in improving trust, that the costs will fall and staff feel happier. No additional funding is required to improve trust although some staff may need communication training.

What I learned as child was that the doctor is the drug, that having trust in your health care professional is the biggest factor to getting well. To comply with a treatment a patient needs to trust the person who gives them it. Being difficult makes it harder for your doctors to fix you. It is not easy for anyone, even a doctor to put your life in their hands.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is a Disability Analyst and is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

https://www.england.nhs.uk/FFTdata

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

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