Traces of Doubt and Sources of Trust

This article analyses the seemingly contradictory developments between seeking trust and demanding control in the field of health care. The author links the debates on trust to the concept of professionalism and changing health policy and practice. Analysis is based on empirical material from a study of modernization of ambulatory care in Germany. Results show that calls are increasing for ‘rational criteria’ and ‘visible markers’ of trust both on the provider and user side, and the new tools of bureaucratic regulation fulfil this function as signifiers of quality. These signifiers are not merely externally imposed rules but actively constructed and utilized by physicians to build trustful relations with colleagues and give ‘public proofs’ of quality of their services under conditions of tighter control and regulation. They are also taken up by patients and perceived as prerequisites for self-determined decisions and trustworthy relations. The traditional ‘embodied’ professionalism, represented by a (male) physician, is hereby transformed into a ‘disembodied’ professionalism, which is founded on information. The highly flexible nature of professionalism allows for transformations according to new demands in health care without necessarily weakening its power and appeal in building trust. Rather than a mere decline, we face new patterns of building trust.