Erosion of Trust in the Medical Profession in India: Time for Doctors to Act

Document Type : Perspective


1 KIT Health, Royal Tropical Institute, Amsterdam, The Netherlands

2 Gokhale Institute of Politics and Economics, Pune, India

3 School of Social Policy and Social Research, University of Kent, Canterbury, UK


In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction.


Main Subjects

Jesani A. Professional codes, dual loyalties and the spotlight on corruption. Indian J Med Ethics. 2014;11(3):134-136.
Sachan D. Tackling corruption in Indian medicine. Lancet. 2013;382(9905):e23-e24.
Jain A, Nundy S, Abbasi K. Corruption: medicine's dirty open secret. BMJ.  2014;348:g4184. doi:10.1136/bmj.g4184
Bawaskar HS. The medical trade. Indian J Med Ethics. 2013;10(4):278.
Medical Council of India website. Accessed October 26, 2016.
Chatterjee P. Trouble at the Medical Council of India. Lancet. 2010;375 (9727):1679. doi:10.1016/S0140-6736(10)60720-9
Tiwari SS. Reforming the medical council of India. Indian J Med Ethics. 2015;12 (1):59.
Vijayakumar K, Saini N. Medical Council of India in a constitutional crisis. J Indian Med Assoc. 2013;111(10):706.
Mani MK. Our watchdog sleeps, and will not be awakened. Issues Med Ethics. 1996;4(4):105-107.
The functioning of Medical Council of India. Department-related parliamentary standing committee on health and family welfare (Report No. 92). India: Parliament of India; March 2016.
Sikri AK. Judgment of the constitutional bench of the supreme court of India, Civil Appeal No. 4060 of Modern dental college and research centre and others versus State of Madhya Pradesh and others. Published May 2, 2016.
Blendon RJ, Benson JM. Public trust in physicians – U.S. medicine in international perspective. N Engl J Med. 2014;371:1570-1572. doi:10.1056/NEJMp1407373
Timmermans S, Oh H. The continued social transformation of the medical profession. J Health Soc Behav. 2010;51(1):S94–S106. doi:10.1177/0022146510383500
Okello DRO, Gilson L. Exploring the influence of trust relationships on motivation in the health sector: a systematic review. Hum Resour Health. 2015;13:16. doi:10.1186/s12960-015-0007-5
Tucker JD, Cheng Y, Wong B, et al. Patient-physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study. BMJ Open. 2015;5:e008221. doi:10.1136/bmjopen-2015-008221
Tucker JD, Wong B, Nie J, Kleinman A. Rebuilding patient–physician trust in China. Lancet. 2016;388(10046):755. doi:10.1016/S0140-6736(16)31362-9
Calnan M, Rowe R. Trust Matters in Health Care. Berkshire: Open University Press; 2008.
Lee YY, Lin JL. Trust but verify: the interactive effects of trust and autonomy preferences on health outcomes. Health Care Anal. 2009;17:244-260. doi:10.1007/s10728-008-0100-1
Pilgrim D, Tomasini F, Yassilev I. Examining trust in health care: a multidisciplinary perspective. Palgrave Macmillan; 2011.
Bruhn JG. Trust and the Health of Organizations. Springer Science; 2001.
Van de Walle S, Marien S. Choice in public health services: a multilevel analysis of perceived primary care doctor choice in 22 countries. Adm Soc. 2015. doi:10.1177/0095399715581047
Gopichandran V, Chetlapalli SK. Factors influencing trust in doctors: a community segmentation strategy for quality improvement in healthcare. BMJ Open. 2013;3:e004115. doi:10.1136/bmjopen-2013-004115
Baidya M, Gopichandran V, Kosalram K. Patient-physician trust among adults of rural Tamil Nadu: a community-based survey. J Postgrad Med. 2014;60:21-26.
Kane S, Calnan M, Radkar A. Trust and trust relations from the providers perspective: the case of the health care system in India. Indian J Med Ethics. 2015;12(3):157-168.
Nagral N, Jain A, Nundy S. A radical prescription for the Medical Council of India: hope for a cure. BMJ. 2016;352:i1731. doi:10.1136/bmj.i1731
Mollering G. The Trust/Control Duality: an integrative perspective on positive expectations of others. Int Sociol. 2005;20:283. doi:10.1177/0268580905055478
Brown P, Calnan M. The civilizing process of trust: developing quality mechanisms which are local, professional-led and thus legitimate. Soc Policy Adm. 2011;45(1):19-34.
Brown P, Calnan M. The risks of managing uncertainty: the limitations of governance and choice, and the potential for trust. Soc Policy Soc. 2010;9(1):13-24.
Frey BS, Jegen R. Motivation crowding theory: a survey of empirical evidence. J Econ Surv. 2001;15:589-611.
Rolfe A, Cash-Gibson L, Car J, Sheikh A, McKinstry B. Interventions for improving patients’ trust in doctors and groups of doctors. Cochrane Database Syst Rev. 2006;(3):CD004134. doi:10.1002/14651858.CD004134.pub3
Bachman R, Gillespie N, Priem R. Repairing trust in organizations and institutions: Toward a conceptual framework. Organ Stud. 2015;36(9):1123-1142. doi:10.1177/0170840615599334