The Trust Deficit: Practical Ways Clinicians Can Restore Patient Trust

Why Does Trust Matter?

Trust between a clinician and patient promotes better patient health outcomes including improved treatment adherence, greater use of preventive services, reduced symptom burden, and higher quality of life. Patients are more likely to disclose sensitive information with a trusted clinician, which gives the clinician an opportunity to help. The evidence spans multiple meta-analyses, RCTs, and observational studies across diverse clinical settings.

How does healthcare delivery create a trust deficit?

The way that modern healthcare is designed can set the stage for initial clinician-patient trust deficit. Lack of transparent policies and practices and uncertain financial motives (Richmond, et al., 2017) combined with financial strain can prevent contact with continuous providers and cause delays in care. There are many layers of complexity in modern healthcare that contribute to fragmentation of care. The shift to centralized electronic scheduling can promote standardization but prevent personalized time slots for care and ultimately prevent access between the patient and the care team. Inefficient ambulatory care teams promote patient distrust through multiple interconnected mechanisms including fragmented communication, documentation burden that displaces relational time, role confusion, provider turnover (Reddy, et al., 2015), and coordination failures that patients directly experience as neglect or incompetence. Often, patients need to wait long periods of time to have access to the right clinician related to a shortage of clinicians and/or lack of adequately covered networks.

From a Patient Point of View: What promotes trust in a clinician?

• Nursing presence: defined as the nurse's attentive, supportive, and therapeutic engagement with patients, is one of the strongest trust-building factors identified in the literature (Yilmaz & Acar, 2026).
• Relational Competency: Trust develops as a dynamic gradual process that is shaped by the clinician's responsiveness and so it has been posited that relational competency should be recognized as a clinical skill (Henriksen, et al., 2025).
• Relational Continuity: A Cochrane Database of Systematic reviews showed that in midwifery, relational continuity (defined as being care for by the same clinician or small team over time) is foundational to building trust (Sandall, et al., 2024).

From the Clinician Point of View: Practical Tips to Restore Trust

• Recognition, remembering patients
• Sustain support and witness/guard infringes on privacy or relational time

(Terenholt, et al., 2025)

• Prepare with intention, Review the chart before the appointment and enter the room with intention
• Create space and recognize that moment in time - Sit down, lean forward, avoid interrupting, and resist the urge to type or formulate a response while the patient is speaking
• Equalize power, positionality and endorse reciprocity (Naughton, et al., 2025)
• Connect patients with system navigators and engage patient with resources
• Small talk, presence, and silence were essential for initiating and maintaining trust (Stenman, et al., 2026)
• Promote leadership that support the design of local context to promote continuity of care (McInnis, et al., 2020)

References

Henriksen SL, Eekholm S, Poulsen I, Kristensson J. The Lived Experience of the Trusting Nurse-Patient Relationship Among Patients Admitted to Internal Medicine Wards. J Adv Nurs. 2025 Nov 3. doi: 10.1111/jan.70344. Epub ahead of print. PMID: 41178808.

McInnes RJ, Aitken-Arbuckle A, Lake S, Hollins Martin C, MacArthur J. Implementing continuity of midwife carer - just a friendly face? A realist evaluation. BMC Health Serv Res. 2020 Apr 15;20(1):304. doi: 10.1186/s12913-020-05159-9. PMID: 32293422; PMCID: PMC7158105.

Naughton S, Baldwin A, Harvey C, Capper T. The midwifery capabilities theory: How midwives enact woman-centered care to address systemic inequity. Birth. 2025 Sep;52(3):472-481. doi: 10.1111/birt.12866. Epub 2024 Sep 19. PMID: 39297756; PMCID: PMC12434215.

Reddy A, Pollack CE, Asch DA, Canamucio A, Werner RM. The Effect of Primary Care Provider Turnover on Patient Experience of Care and Ambulatory Quality of Care. JAMA Intern Med. 2015;175(7):1157—1162. doi:10.1001/jamainternmed.2015.1853

Richmond J, Powell W, Maurer M, Mangrum R, Gold MR, Pathak-Sen E, Yang M, Carman KL. Public Mistrust of the U.S. Health Care System's Profit Motives: Mixed-Methods Results from a Randomized Controlled Trial. J Gen Intern Med. 2017 Dec;32(12):1396-1402. doi: 10.1007/s11606-017-4172-1. Epub 2017 Sep 5. PMID: 28875447; PMCID: PMC5698226.

Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, Jones LV, Shennan AH, Rayment-Jones H. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2024, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub6. Accessed 28 April 2026.

Stenman T, Holmberg B, Rönngren Y, Näppä U, Johansson CM. Confidential Conversations in Palliative Care: An Ethnographic Exploration of Trust and Interpersonal Relationship Between Nurse and Patient. J Clin Nurs. 2026 Apr;35(4):1737-1751. doi: 10.1111/jocn.70119. Epub 2025 Sep 30. PMID: 41029965; PMCID: PMC12964502.

Torenholt R, Langballe R, Tjørnhøj-Thomsen T, Dalton SO, Bidstrup PE. Nurturing Patient Trust: A Qualitative Study of the Interaction Between Vulnerable Lung Cancer Patients and Nurse Navigators in the Intervention Study NAVIGATE. Psychooncology. 2025 Oct;34(10):e70299. doi: 10.1002/pon.70299. PMID: 41137371.

Yilmaz A, Bakiş Açar Ş. The mediating role of nursing presence in the relationship between trust in nurses and satisfaction with nursing care in oncology patients. BMC Health Serv Res. 2026 Apr 22. doi: 10.1186/s12913-026-14459-5. Epub ahead of print. PMID: 42021224.