Trust is not simply given in medicine—it is earned, nurtured, and sometimes restored. I learned this lesson firsthand as a medical student on my first clinical rotation at the VA hospital. My attending physician was a seasoned internist with a direct but deeply knowledgeable approach, and my patient, I will call them Mr. Thompson, was a Gulf War veteran who had long distrusted the medical system. As a young trainee, I found myself navigating different generational values and approaches to care.
Mr. Thompson had been admitted for heart failure exacerbation, and his chart was filled with notes about his reluctance to adhere to medical recommendations. He resisted interventions, questioned every test ordered, and bristled at what he perceived as “textbook” explanations. He distrusted medical authority, citing past experiences where he felt unheard when his wife was dying.
In contrast, my attending valued efficiency and expertise; he had seen how swift decision-making could improve outcomes, and he approached patient interactions with a focus on providing the best possible care within the constraints of a busy clinical setting.
As a student, I had more time than my attending, so I sat with Mr. Thompson whenever I could. I listened to his stories, listened to his concerns, and gradually earned his trust.
One morning, he surprised me by asking, “What would you do if you were in my shoes?” I hesitated, aware of the weight of his question. Instead of giving a direct answer, I shared what I had learned about his condition, his options, and the likely outcomes. We discussed his fears, his hopes, and his goals of care. He nodded and finally agreed to a diuresis plan—a breakthrough moment that highlighted the importance of shared decision-making.
When I presented this to my attending, he offered a different perspective. “It’s important to guide patients without overwhelming them,” he said. “They need us to help them make the best decision for their health.” This moment forced me to reconcile two professional ideals: the authority of medical expertise and the necessity of patient-centered trust. I realized that trust is not a static expectation but an evolving dialogue.
Mr. Thompson did not need blind reassurance—he needed to feel like an active participant in his own care. My attending, too, had a valid perspective, shaped by decades of experience where clear, direct guidance had helped countless patients navigate complex medical decisions.
Over the following days, I continued to work closely with Mr. Thompson. We spoke not only about his medical condition but also about his experiences in the military, his family, and what mattered most to him. In these conversations, I saw how trust was built—not through grand gestures, but through small, consistent acts of presence and understanding. He began to express more confidence in our team’s recommendations, and by the time he was ready for discharge, he was engaged and motivated in his care plan.
While medical knowledge and efficiency are critical, they must be balanced with empathy and partnership. The generational divide between my attending and Mr. Thompson was not just about differing communication styles—it reflected broader shifts in medical professionalism. The traditional model of medicine emphasized physician authority, while modern expectations prioritize shared decision-making. Neither approach is inherently right or wrong, but bridging them requires adaptability, humility, and, above all, trust.
Max Holt is a second-year medical student at the University of Iowa Carver College of Medicine with a background in biology and philosophy from Luther College. He is interested in gastrointestinal research, rural health, and medical ethics, and is currently involved in projects on rib fracture management and colonoscopy access in rural populations.