Dependence, trust and agency? Exploring contingency within the lay-professional interface

Recent shifts in roles within the doctor and patient has rendered the concept of trust less clear and increasingly difficult for sociologists to measure, conceptualise and operationalise in medical encounters. Although it is well acknowledged within social theory that patient (dis)trust is shaped by both structure and agency, the latter remains a moot point due to links between trust, vulnerability and dependence. This paper develops social theory around trust in the light of data from research investigating the dualistic nature of patient trust in medical professionals and the medical system. Data from two PhD theses are presented; one investigating the experiences of cervical cancer patients and the nature of their trust in their healthcare in the UK (20 qualitative interviews), and the second investigating coronary heart disease patients’ trust in medical professionals in Australia (37 qualitative interviews). The findings of these PhDs are discussed in relation to the dualistic nature of trust. Firstly, our findings identify the notions of dependence, vulnerability and reflexivity as prominent features shaping individuals’ capacities to act with regards to (dis)trusting medical professionals and the medical system. Secondly, our findings identify how the structure of the healthcare system (the UK NHS and the Australian Medicare and private practice) influence or limit patients’ choices or opportunities to (dis)trust medical professionals and the medical system. Our findings and discussions are salient for the development of a more comprehensive social theory of trust – one that is more amenable to robust conceptualisations and operationalisations of trust in empirical medical-sociological research.