BACKGROUND. Patients' trust in their physicians has recently become a focus of concern, largely owing to the rise of managed care, yet the subject remains largely unstudied. We undertook a qualitative research study of patients' self-reported experiences with trust in a physician to gain further understanding of the components of trust in the context of the patient-physician relationship.
METHODS. Twenty-nine patient participants, aged 26 to 72, were recruited from three diverse practice sites. Four focus groups, each lasting 1.5 to 2 hours, were conducted to explore patients' experiences with trust. Focus groups were audio-recorded, transcribed, and coded by four readers, using principles of grounded theory.
RESULTS. The resulting consensus codes were grouped into seven categories of physician behavior, two of which related primarily to technical competence (thoroughness in evaluation and providing appropriate and effective treatment) and five of which were interpersonal (understanding patient's individual experience, expressing caring, communicating clearly and completely, building partnership/sharing power and honesty/respect for patient). Two additional categories were predisposing factors and structural/staffing factors. Each major category had multiple subcategories. Specific examples from each major category are provided.
CONCLUSIONS. These nine categories of physician behavior encompassed the trust experiences related by the 29 patients. These categories and the specific examples provided by patients provide insights into the process of trust formation and suggest ways in which physicians could be more effective in building and maintaining trust.
KEY WORDS. Communication; physician-patient relations; patient-centered care; focus groups. (J Fam Pract 1997; 44:169-176)
In medicine the yearning by consumers to be seen as individuals is particularly poignant because the relationship between doctor and patient is in many ways so intimate--and, too often, so distant.
The relationship between patient and physician is at the heart of the process of good medical care, yet remains largely unmeasured and unstudied. Current changes in the delivery of medical care, most obviously those occurring under the rubric of managed care, have potentially profound effects on the patient-physician relationship. For example, a patient's choice of physician may be restricted by the health plans offered by his or her employer. Continuity with the patient's usual physician may be lost because of changes in plans offered by the patient's employer or changes in the plans in which the physician participates. Managed care organizations place primary care physicians in the position of "gatekeepers" for specialty care and access to diagnostic tests, a role viewed with suspicion by many patients. As a result of these factors, patients may enter their relationship with a physician with a lower level of trust. In addition, pressure to increase the efficiency of outpatient medical care may result in shorter appointment times, less continuity between outpatient and inpatient care, larger provider groups, and reduced access to the patient's personal physician for urgent appointments.
Results from a large national study found that patients in health maintenance organizations had a lower proportion of health-related visits to their primary physician, and were less likely to still be with their primary physician at the end of the...
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