Ipancia Belace, a middle-aged woman, sat in the chair next to my desk as I was taking a history from her.  She had been a patient in our clinic for several years and made regular visits to us for mild high blood pressure and various aches and pains.  She took a small pill bottle out of her purse and handed it to me.  “My daughter sent me this medication, but I haven’t taken it because I wanted to check with you first.  One can’t just take any medication without checking with their doctor, you know”, she said with an air of confidence.  I looked at the bottle and it contained generic acetaminophen.  In fact, I recognized the bottle as one that came from the dollar stores in the US.  “This is a good medication”, I said.  “We prescribe this all the time – it’s the same as the medication that comes in the blue package (our acetaminophen is packed in a blue blister pack).”  I handed the bottle back to her, but, instead of putting it back in her purse, she took off the cap and handed it back to me.  I could tell she wasn’t convinced that I knew what was in the bottle, so I said, “I know this medication well and it’s very good.  It’s a long white pill and it’s good for pain”.  I noticed that the seal was unbroken, so I handed the bottle back to her.  I got up and examined her heart and lungs, had her lie down on the examination table to feel her abdomen, then we both sat down and I started to write on her chart.  Out came the bottle again.  This time she had broken the seal and poured out some of the acetaminophen caplets into her hand.  “You see”, I said, “just what I told you.  This is a good medication and it’s fine for you to take it.”  I turned back to my writing and she sat there looking at the bottle.  Finally, with an attitude that said she had made her final decision, she put the cap back on the bottle and stuffed it in her purse.  “I want you to sell me your medication”, she said.  “I trust it more.”

Trust – difficult to obtain and easy to lose.  This is what we’ve been building for the past four years in our little tin-roofed clinic.  TRUST.