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By Michael Calnan and Rosemary Rowe . Published by McGraw Hill Education 2008 . Paperback , 224 pages . RRP $152.95 ISBN: 9780 3352 2283 4

Reviewed by Colin Binns

School of Public Health, Curtin University, Western Australia

This volume is one of a series of monographs issued under the banner title of ‘State of Health’. The authors argue that trust is one of the basic tenets of healthcare: trust appears to be necessary where there is uncertainty and a level of risk. And of course all healthcare involve some level of risk.

The book contains some useful and comprehensive discussions of the definitions of, and theories behind trust. The chapters are structured around functional components of the National Health Service in the UK. Trust in the NHS, Trust between patients and clinicians, Trust between clinicians, Trust between clinicians and managers and patients, and finally Trust still matters in healthcare. The last chapter has a question mark after it, suggesting an element of doubt the author's minds.

The book is organised around two major research projects, the care of diabetics in primary healthcare and hip replacement surgery. These are actually areas of healthcare with substantial knowledge bases, but with varying quality of outcomes for individual patients. Some of the individual case studies are interesting. Many clinicians will relate to the conversation reported on page 132:

“Do you trust managers?”

Consultant: “Not an inch.”

“Why not?”

“Because they are solely interested in advancing themselves up the greasy pole of management, and satisfying certain directives from the government which are inappropriately targeted. The previous manager ‘X’…. because we trusted him he was removed. I thought he was doing a really good job, but he was just a little bit too friendly with the consultants. He was too sympathetic to our concerns.”

The constant tension between healthcare managers and those responsible for patient care is not unique to one country.

The book is rather light on discussing the other factors involved and quality of outcomes, but as part of a series of monographs is this understandable. Trust can be misplaced and there are several high profile cases in Australia where incompetent professionals have still been trusted by their clients. The element that seems to be missing is the ability of clients to access information that enables them to balance trust with objective measures of outcome. It seems almost that the Internet age had not reached the UK and when the studies were carried out. Although in fairness this topic is partly addressed in the concluding chapter.

I was amazed to read the following paragraph: “Patients tend not to have a relationship with managers but many decide whether they trust them based on the cleanliness of the hospitals and clinics they attend. Hygiene is an indicator of managerial competence and where this is considered poor, patients reason that they cannot trust managers to be effective in other areas of health service delivery.” Why do we still have to wonder about hygiene in hospitals in the 21st century?

The book does not address prevention or other public health issues. In primary healthcare settings patients are entitled to trust that their carers will address the issue of reducing the risk factors for diabetes.

Overall, the book is well written and referenced and follows a logical progression its discussion. It is an interesting commentary on trust in the context of the National Health Service and would be a useful addition to medical libraries.