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DOCTOR-PATIENT RELATIONSHIP

, MD, MS|September 22, 2021

Caring for patients is a remarkable responsibility. Patients believe that their physicians will manage their health and private information with integrity. This dynamic puts patients in a vulnerable situation where they are dependent on trust.

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Compassionate doctor holding hands of patient

Recent surveys indicate that, for the most part, patients trust their physicians. But that doesn't mean there isn't room for improvement.

“Trust is one of the essential components and a fundamental part of the doctor-patient relationship,” according to the authors of a literature review published in the Journal of Healthcare Communications. “In general, to trust means to believe that someone is honest, nice or good, and will not harm you. In the medical field for some patients, it can be their belief or expectation for the physician to behave in a certain way. Patients might expect their healthcare provider to be competent, compassionate, honest, empathic, dependable, and interested in their good will and expect a good outcome of their visit. Trust in a doctor-patient relationship is something that involves both confidence and reliance.”

Considering how important trust is in the physician-patient relationship, here’s a look at the status quo, as well as ways in which a physician can facilitate patient trust.

The numbers on trust

Various organizations have surveyed the public on the trust that they place in physicians. Overall, the numbers are encouraging.

According to a survey conducted by the Pew Research Center, 74% of Americans responded that they had a mostly positive view of their physicians. Furthermore, nearly 50% or more of respondents noted that physicians care about the patients’ best interest (57%), do a good job offering diagnoses and treatment recommendations (49%), and provide fair and accurate information when advising patients (48%). Conversely, smaller numbers believed that physicians were transparent about conflicts of interest with industry groups (15%) or were willing to be forthright about mistakes made during care (12%).

Results from a UChicago Harris/AP-NORC Poll conducted in 2021 also point to a solid foundation of trust. Overall, 70% of respondents said they trust their physicians. Intriguingly, when broken down by political party, 72% of Republicans said they trusted their physicians vs 77% of Democrats.

With respect to other healthcare professions, 79% of respondents claimed that they trusted nurses, 75% trusted pharmacists, and 22% trusted hospital executives. 

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Building patient trust

According to the authors of the aforementioned review, trust is earned and maintained. Communication and interpersonal skills are key to trust building, as highlighted by the Accreditation Council for Graduate Medical Education. The authors cited research indicating patient preference for communication that is evidence-based and reflective of shared decision-making.

In a study involving patients with HIV, researchers found that respect and partnership were key in developing a trusting relationship. They wrote that “respect means that providers listen to them, treat them as individuals and not just as patients, and value their knowledge of their own bodies and illness experiences.” 

As for partnership, patients returned to providers who were “open, discussed options with patients as equals, educated patients as necessary, and allowed patients to direct their own care if that was what they wanted.”

Physicians can actively practice certain skills to boost trust among patients. 

An article published in The Hastings Center Report evaluated a group of studies performed in the late 1990s to early 2000s in which researchers began to develop scales to measure trust in medicine.

“Aspects of the physician–patient relationship that these studies found to be central to trust were physicians’ perceived caring and competence, as displayed through interpersonal skills such as careful listening, eye contact, clear communication, and conveying understanding of patients’ experiences,” the author of the review wrote. “In these studies, trust was clearly distinguished from satisfaction and was understood as a learnable skill, not a dimension of physician or patient personality.”

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The author also noted that mistrust of physicians seemed to be more deep-seated in minority vs White populations. 

According to the article, trustworthiness is influenced by physician competence and caring. Competence is needed to meet entrusted responsibilities in a dependable and reliable fashion. Caring facilitates the process.

The author also suggested that a good step in establishing trust is to air out any concerns. 

“Unless clinicians attempt to display their comprehension of patients’ particular expectations and concerns about the medical encounter, they will not be seen as trustworthy, and a trusting relationship will not be established,” she wrote. “While making the attempt poses a risk of misunderstanding and offense, the potential benefits are substantial. The attempt can contribute to a gradual chipping away at the atmosphere of mistrust that frustrates the patients seeking care and the professionals who are in a position to provide it.”

Bottom line

The good news is that most people appear to trust their physicians. Nevertheless, trust is something that must always be focused on and enhanced. Keys to strong trust include communication, partnership, and interpersonal skills. In many situations, trust must be earned via allied, compassionate, respectful, and attentive care. Fortunately, there are steps that physicians can take to further establish trust.

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