Conversation with PROF. DR. PETER VAJKOCZY

The basis of trust is individual credibility. This is based on factors such as integrity, intent, skills and results, which are linked together like the parts of a tree. Integrity and intent are to do with character, while the other two concern competencies. Prof. Peter Vajkoczy is a famous German neurosurgeon who also carries out research in the field of neurosurgery. Talking to him about trust in terms of these four factors also involves his professional domain and the findings that have emerged.

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CHRISTIAN BRACHT: Trust is something you have to work hard over a long period of time to earn. In today’s society we’re seeing a decline in trust with regard to institutions, politics and the media, but not with regard to doctors. How do you explain that?

PROF. PETER VAJKOCZY: I too am just a normal citizen observing what is happening around me. Only yesterday I asked myself why politicians are so unsatisfactory at communicating certain issues to people. My answer is that it’s a result of too much short-term thinking. I think people sense short-termism in decision-making and opportunism with regard to certain issues. But trust is always a long-term matter and a long-term promise. It builds on character traits, competence, experience and results that have been achieved.

CB And I would say that integrity plays a significant role and is responsible for doctors being trusted.

PV I would attribute a lot more to the zeitgeist and the speed with which things are changing and also the need to please the masses. That’s not something you can build on over the long term. If circumstances change quickly, or if a decision was wrong and is then changed, this creates mistrust.

CB It’s not only trust in institutions that has declined, but trust in the role of the media too. Doesn’t that affect us?

PV I don’t think trust has lost anything in terms of its value. We’re continually being flooded with a great deal of information and that’s where a certain amount of paranoia can arise. This makes us ill, because at some point we no longer know which side we’re on, or we can no longer tell right from wrong. This inability and difficulty in creating an informed picture for oneself, coupled with the feeling of being manipulated, creates a high level of mistrust. This can then go so far as to make your lose your compass sometimes – and that comes very close to a fundamental loss of trust.

CB But then how can I restore order?

PV Everything has become increasingly dynamic and the half-life of information or news has changed. We’ve become inured to scandal to an extent and also very quickly forget. Our mentality is one of stimulation and repression. I think in order to restore order, you need a lot of trust in yourself.

CB Let’s go back to trust in doctors and the medical profession in general. PV Actually, doctors have often aroused mistrust. When we talk about unnecessary operations or payments, a different picture often emerges. During the pandemic, however, society understood the importance of health and good healthcare. Doctors generally have a positive impact and were able to build trust through the pandemic. I believe that the profession conveys a certain degree of seriousness and that there is a certain level of

trust in it. As I said, trust can also be betrayed, but it’s nice that we have this little bonus at least.

CB Trust is also to do with transparency. You often have to give patients quite brutal information in a very direct way.

PV Do I? I think that sensitivity and a sense of what information the other person would like to hear are paramount. And when we talk about trust, the level of trust between doctor and patient and vice versa is crucial. You have to work on it and the chemistry between the two has to be right. One secret is that the doctor gets a sense of how far he or she can go and how far it is reasonable. Of course, if you’re frank about things you also lose a certain degree of hope. Medicine isn’t a one-hundred-per-cent discipline, and biology certainly isn’t, and that’s why it’s sometimes difficult to have such an absolutist opinion. You have to be open and transparent, and it’s important to be honest up front in your assessment of the possibilities. I’m sure people appreciate that honesty.

CB And what about ethical principles?

PV I think it’s much more important that you represent traditional values, that you have humility and maybe also a sense of values. People are really looking for this again, which brings us back to the notion of a compass.

CB And empathy!?

PV Empathy plays a very important role in the medical profession. You learn medicine in medical school. It’s learning by doing. You have to find your own style. I choose my young colleagues accordingly. They can all learn the technical side, but it’s hard to learn what’s valuable. That’s not something you’re born with. Our individual socialisation and family teach us how to be as human beings. And that can be seen, for example, in how you talk with patients, and if you don’t hide yourself away in the face of complications, but seek out dialogue instead.

CB And what about your personal sense of trust?

PV I trust people who have worked with me and known me for a long time, such as my wife and friends. I trust my mentors, of whom I have four or five, because they give you their frank opinion. I think there are a handful of people in life that you really confide in. And I have trust in our healthcare system, even if there’s still a lot of room for improvement. ●