Healthcare trust becomes most consequential when patients cannot independently verify what clinicians or institutions know, whether recommendations are reliable, or how competing risks should be interpreted. Yet trust is often treated as a stable attitude or a single relational outcome. This conceptual article argues instead that healthcare trust is an uncertainty-sensitive judgment formed across interpersonal and institutional levels. Evidence concerning clinician behavior, participation, communication, organizational reputation, technological governance, prior encounters, and structural treatment provides patients with imperfect signals from which confidence or doubt may develop. The article distinguishes trust from trustworthiness, competence from benevolence and integrity, interpersonal confidence from system trust, and trust from distrust. It further treats information asymmetry and dependence as conditions that simultaneously constrain independent verification and create a need for interpretable evidence of trustworthiness. Building on these distinctions, the article develops a proposed multilevel account of trust formation, updating, rupture, and repair. The framework is explicitly theoretical rather than empirically validated and is bounded by differences in illness, culture, institutional history, digital infrastructure, power, access, and accumulated experience.
