Most people, should they be in need of a transcatheter aortic “valve-in-valve” replacement procedure for a failed aortic valve replacement, would be delighted to have one of the world’s foremost experts (who has performed over 6,000 of these procedures at one of the world’s foremost heart hospitals) perform the procedure.

But not my father, despite having dyspnea on mild exertion owing to a trans-valvular gradient of 50 mmHg.

Naturally, he wanted a second opinion.

Who do you get a second opinion when the first opinion is from a well-respected expert?

My father chose his long-time cardiologist, who lives in a different state from the planned procedure, and who does not perform the procedure.

Only after his long-time cardiologist gave his blessing for both the procedure and the proceduralist did my father agree to it.

Why not take the advice of one of the world’s foremost experts? That is, after all, why you go to one of the world’s foremost experts.

What’s the psychology behind this?

Trust, built on long-term relationships.

Imagine the people you trust. Usually, they have some combination of:

• Commonality (think how quickly we bond with people who come from or live in the same place, have a similar job, root for the same teams, etc.)
• Reliable information
• Expertise
• Personal experience of enjoyable and mutually-beneficial reciprocal relationships (e.g., family, friends). We take advice from those whom we trust. And we trust those with whom we’ve had good relationships and positive outcomes over a long time.

Patients who trust their physicians are more-adherent to diagnostic and treatment plans. (As my brother, a successful serial entrepreneur, phrased it: “People do things for people they like and trust.”) Trust between physicians and patients leads to more satisfying interactions for both parties, better outcomes, less burnout, and fewer lawsuits.

As a social species, we’re “wired” to develop small networks of trust. Trust triggers the release of dopamine and oxytocin (the “reward” and “bonding” neurotransmitters, respectively) in the brain. These are particularly released among persons with long-term relationships (in friendship, love, or business). Basically, trusting and being trusted makes us feel good, and that, in turn, perpetuates the trusting relationship.

In contrast, high stress is a potent oxytocin inhibitor. Being recommended for heart surgery is high stress. I imagine that, for my father, the stress of considering heart surgery led him to seek counsel from someone with whom he’s bonded for a long time and who triggers his oxytocin: his cardiologist.

If you’re at the top of your field, remember that, despite your professional status, patients may not trust you at first, simply because they haven’t known you for long. Trust may still need to be developed.

If you’re at the start of your career (such as in training) and are concerned about what you have to offer the patient, remember that trust earned through caring over time is the foundation and stepping stone of a therapeutic relationship. As President Theodore Roosevelt said, “No one cares how much you know until they know how much you care.”

What can we physicians do to quickly build trust with patients, especially in medical fields (such as emergency medicine or anesthesiology) where there’s very limited visit time to do so, and the expectation is not for a long-term relationship?

The author is an anonymous physician.