XX has made many interesting points(ref), and we welcome the opportunity to develop the ideas of ‘Too Much Medicine, Not Enough Trust’ (1). We will address: (i) the asymmetry between the trust that patients extend to doctors, and the trust that doctors extend to patients; (ii) our reasons for doubting that litigation or complaints reflect a betrayal of the patient-doctor relationship and (iii) the importance of institutional trust, both for the doctor and the patient.