Trust

To believe in the integrity, confidence, and reliance of another.

Imagine you were in the middle of the Pacific Ocean, there was not a soul you could depend on, and your life could only be saved by one person, a person you knew from college as a deceiving and untrustworthy human being. The reality and importance of this situation is evidently clear when considering trust in the life of a person, society, or the world, even if this story is fictional.

Now, imagine you were airborne in a commercial airliner, negotiating altitude at the eye of a heavy storm. And, image your life depended on the knowledge and ability of the plane's captain, who had suffered a mild stroke and was unable to perform optimally. The co-captain, with less experience, immediately took over control of the faltering plane although with less predictable results. When considering this possibility, trust, again, represents the essence of continuing survival.

Imagine once more that your welfare relied on the dedication and participation of poorly prepared health professionals and that you were not sure you were receiving the best health care. Imagine you could not accept their care if your life depended on it. Your future, suddenly and dramatically, becomes threatened and purposeless. Trust is missing!

The previous examples reflect very clearly the far-reaching dimensions and overwhelming, encompassing effects of trust. Trust means to believe in the integrity and reliance of another. According to Webster's Dictionary, trust is “to have confidence in; to expect with assurance; to believe in someone in whom confidence is placed” [[1]]. Confidence, at the same time, is to have “certainty in the trustworthiness of another” [[1]]. Trust and confidence come from the same tree and represent the same family. They are basically the same word with a different wrapping. Confidence is “the assurance that someone will keep a secret” [[1], [2]].

How is it then that surgeons utilize trust in the evolving and changing relationships of their profession? How is it that surgeons cannot proceed further without the enduring presence of trust? How is it that surgeons cannot practice their art or science under trustless circumstances? The response is so evidently clear that an explanation appears to be hardly required and mostly redundant. Surgery and trust are synonymous with good practice. Surgery and trust coexist at all times. Surgery and trust cannot exist apart from each other.

If trust is so uniquely important, how can we then teach it to new generations of practicing surgeons? If trust is so particularly inherent to good practice, how can we then advance its very much-needed presence? If trust is of such a paramount significance, how can we then characterize its value?

As we advance the quest for the teaching of values to the surgeons of tomorrow, I remain mindful of the complexity associated with this especially extraordinary endeavor. Many other virtues or human qualities, such as compassion [[3]], respect [[4]], integrity [[5]], commitment, and now trust, continuously interact with each other. They intimately depend on the functions of the other. They cannot be orchestrated in practice without a consideration for one another. They all work together and practically at the same time. It is inconceivable to think that compassion could exist without integrity and that integrity could appear without commitment or trust. Compassion—respect—integrity—commitment and trust are, in the end, represented in the same congregation of uplifting and profound human values. We need them all to achieve a positive and worthwhile existence.

Let us now concentrate on the surgical arena where surgeons, residents, and assistants frequently enter the surgical theater to realize the most sacred act of healing. There trust constitutes an unique and particularly special quality that transcends the attributes of other functions, because without trust we cannot effectively advance the patient's surgical care. Trusting your surgical mentors, partners, and associates will permit the full integration of the operative act and will, at the same time, enhance the possibility of success.

Trust constitutes life for the surgeon. Without it, surgery is incomplete, surgery is not itself, surgery is highly deficient. To instill trust in the training and practice of the surgeon is vital. To understand and recognize anatomy, to understand and explain physiology, to understand and analyze pathology, and to understand and perform surgery, trust is fundamentally and practically essential. Trust is the missing link of the practicing surgeon. Trust is required for the evolution of surgery!

Trust in science, trust in personal surgical accomplishment, trust in human capability, and trust in patient care are all critical elements of the surgeon's world. It is imperative then to cultivate and continuously support endeavors directed at maintaining the highest standards of trust. When trust is reached, professional and personal qualities are clearly enhanced in an ideal manner. Consider trustworthiness as the most unique factor in the life of anyone [[2]], in the life … of a surgeon.

From the times of Zabdiel Boylston (1679–1766), who first published accounts of elective surgical operations in the American British colonies [[6]], to the extraordinary contributions of William S. Halsted (1852-1922) [[7]], trust has been at the forefront of the American surgical profession. Zabdiel Boylston exuded trust and demonstrated its significance as he dealt with the pioneering surgical cases of early eighteenth century America. Patients and families had trust in the activities and surgical ability of this Boston surgeon. When Boylston attended his patients, especially during the 1721 smallpox epidemic, he stood at the center of trust and confidence.

William Halsted, equally as accomplished as Zabdiel Boylston but living in modern times, clearly advanced the surgical sciences through his innovative capacity and his uniquely qualified personality, which stimulated and maintained trust at the cusp of his professional activity [[7]]. William Halsted constantly revealed his deep knowledge and unique intuition in the surgeon's profession, and by doing so, faculty, residents, and patients placed an incalculable amount of trust in all his surgical decisions and activities.

Other distinguished American surgeons of earlier times, such as John Jones (1729–1791), Philip Syng Physick (1768–1837), Ephraim McDowell (1771–1830), John Syng Dorsey (1783–1818), William Beaumont (1785–1853), Valentine Mott (1785–1865), and many more, brought with them, in various ways, a great deal of information, understanding, respect, compassion, trust, and integrity [[7], [8]] to the American scene. Each one of these basically uplifting qualities was an intricate part of the life and work of these pioneer surgeons.

Trust is among the most needed qualities in the business world, as described by Peter Krass in his enlightened Book of Leadership Wisdom [[9]], or Peter Cohan in his excellent writings on Value Leadership [[10]], or Francis Fukuyama in his extraordinary book of Trust [[11]]. As essential as trust is for business leaders, it is equally essential for surgeons who are learning their craft or practicing their profession. Trust is indispensable for surgeons' patients and colleagues in order to build a world of confidence and understanding. In the same manner, David Packard (1912–1996) of Hewlett-Packard fame had a strong belief in people and dedicatedly argued for the unique value of trust in the life and work of others [[9]].

What lessons can be learned by upcoming surgeons in the arena of trust? Is there a way for this quality or virtue to be continuously presented and spread in the walls of academia and surgical practice? Yes. I think the use of clear examples of trust in society, history, and literature are very valuable tools. I think the direct participation of surgeon-teachers in alerting and stimulating young specialists to be trustworthy in their endeavors creates the necessary atmosphere to keep trust alive at all times. I think that emphasizing trust as a way of life and style of professional commitment is extremely helpful. I think trust is a lifetime virtue from which students and teachers alike derive their energy and enthusiasm in carrying out their noble careers.