When expertise isn’t enough: Rebuilding trust in medicine

Patients and families are navigating an overwhelming mix of accurate information, misinformation, and personal influence before they ever step into a clinic. By the time the visit starts, the conversation is already underway. For clinicians, that means our role has expanded. We are not just providers of care. We are interpreters, partners, and, increasingly, rebuilders of trust.

There are a few consistent approaches I’ve found that influence whether trust takes hold and whether patients ultimately act on the care they receive.

The starting point has shifted

I have been in pediatrics for a long time, and what has changed is not the science. It is everything around it. Families walk in today with far more information than they used to. Some of it is helpful. Much of it is not. It is not just information anymore. It is misinformation and disinformation–often coming from sources that feel credible and personal.

That shift has changed how I think about my role. It is no longer enough to be right. If I want to influence decisions and outcomes, I have to be trusted.

I did not grow up in medicine. I was the first in my family to graduate from college, and I did not follow a clear path into this field. What I knew early on was that I wanted to work with children and families – and that is still what I value most about this work. Even now, in a leadership role, I have stayed in clinical practice because it keeps me grounded. It reminds me what this work actually looks like in real time, in a room with a family trying to make decisions.

Those decisions have become more complex–not because the medicine is less clear, but because the context around it is more complicated. When I was growing up, going to the doctor was more straightforward. You went when you needed care. There were fewer routine visits and far fewer external influences shaping how families thought about healthcare decisions.

Today, families often arrive having already formed opinions. They have had conversations, done their own research, and been exposed to a wide range of perspectives before I ever meet them. That changes the starting point of every visit.

Trust is a practice, not a moment

If I do not have a trusting relationship with a family, I am not going to move the dial. It does not matter how strong the evidence is or how clear the recommendation may be. Without trust, the information does not land.

What I have learned over time is that trust is not built through a single conversation; it is built through a series of small, consistent interactions.

It starts with how I enter the room. If I begin by immediately outlining what we are going to do without first getting to know the family, I lose the opportunity to connect.

Instead, I ask questions. I want to understand how they found our practice, how their child is doing, and what is happening in their lives outside of the clinic.

These are not extras. They are essential. I am not just caring for a patient. I am caring for a family, and if I do not understand that context, I am likely to miss what matters most.

Most resistance is uncertainty

One of the most important shifts in my approach has been how I interpret disagreement. It is easy to label families as resistant when they question recommendations. I try to approach those moments differently.

Most of the time, what I am seeing is not opposition; it is uncertainty, often driven by fear.

This is especially visible in conversations about vaccines, but it applies more broadly. I do not think of most families as refusing care. I think of them as hesitant. That distinction matters because it shapes how the conversation unfolds.

Rather than telling families they are wrong, I ask them to explain their concerns.

The answers vary. It may be something they saw online, something a family member shared, or something that simply did not feel right to them. If I do not take the time to understand those concerns, I cannot effectively address them.

I also do not expect those conversations to be resolved in a single visit. Building trust is a long-term process. It requires consistency and follow-through.

I revisit concerns over time, answer questions as they arise, and provide information that families can take with them and consider outside of the clinic.

Over time, that approach leads to progress. It may not always look exactly the way I would have expected earlier in my career, but it moves families forward.

Clinicians are no longer the only voice

At the same time, clinicians are no longer the only source of influence. Families are engaging with information across a wide range of platforms, including social media and online communities. Many of these voices are effective communicators, even if the information they share is not accurate.

Healthcare has not always adapted quickly to this shift. There is still a tendency to rely on expertise alone. But expertise without accessibility or presence in these spaces is no longer sufficient.

We have a clear opportunity–and a need–for healthcare organizations and providers to engage more directly and thoughtfully in the environments where patients are forming their opinions.

What 20 minutes has to accomplish

Time constraints add another layer of complexity. In primary care, visits are often limited to about 20 minutes. Within that time, there are multiple priorities to address. It is not possible to cover everything in depth.

That reality requires a different approach. It requires focusing on what is most important in that moment.

What is the most important conversation for that visit? What will have the greatest impact?

Not every issue needs to be resolved during a single visit. Instead, the goal is to address the most critical concern while continuing to build a relationship that allows for ongoing dialogue.

The work still happens in the exam room

Trust, in this context, is not separate from care. It is foundational to it.

In my experience, trust is built in the exam room. It is built through conversations that are not always easy or straightforward. It is built in the moments when I choose to listen instead of react – especially in moments of disagreement.

There are times when those conversations are challenging. There are moments of frustration. But responding with an argument does not move the relationship forward.

Remaining calm, consistent, and present does.

Applying trust in everyday practice

For clinicians, the takeaway is clear: Trust can no longer be assumed. It must be developed deliberately over time.

That is true in medicine, but it is not unique to medicine. Across industries, people are making decisions in environments filled with competing information and competing voices. Expertise still matters, but it is no longer enough on its own. The ability to build trust consistently and credibly is becoming a defining skill.

In practice, this does not require a completely new playbook. It requires discipline in how we show up in every interaction.

It starts with connection. Before offering guidance, people need to feel seen and understood. It requires curiosity. Asking what someone believes, and why, often reveals more than immediately trying to correct them. It also means being honest about uncertainty without losing confidence. People can handle nuance, but they need a steady, informed voice to help them navigate it.

In practice, this comes down to a few consistent behaviors:

• Start with connection, not content.
• Lead with curiosity.
• Be honest about uncertainty while staying confident.
• Take a long-term view of trust.
• Be present in the spaces where decisions are shaped.
• Focus on what matters most in each interaction.

None of these changes the science of medicine. It changes how science is received.

If we adapt to that reality, the work becomes more effective and, in many ways, more meaningful. If we do not, even the strongest evidence will struggle to take hold.