According to information in the article, "Patients with greater trust in their physicians are more satisfied with their care, more likely to adhere to their physicians' recommendations, and less likely to change physicians." Little is known about how patients' characteristics and experiences are related to trust in their specialist physicians.
Nancy L. Keating, M.D., M.P.H., of Harvard Medical School, Boston, and colleagues surveyed 417 patients who were seeing a medical specialist (cardiologist, neurologist, nephrologist, gastroenterologist or rheumatologist) for the first time in a hospital-based practice. The average age of the patients surveyed was 50 years, and 74 percent were white, 76 percent were women, and 56 percent were college graduates.
The researchers found that most patients reported having good experiences with their specialists, and 79 percent reported complete confidence and trust in their specialist when they were interviewed one to two weeks after their initial visit. However, the authors also found that black patients had lower levels of trust than white patients.
The researchers also found that "In analyses that adjusted for patients' characteristics and their reports of their experiences with the consultant, trust was higher for patients who reported that the specialist provided enough medical information; explained what to do if problems or symptoms continued, got worse, or came back; listened to what they had to say; and involved them in decisions as much as they wanted. Trust was also higher among patients who reported that they spent as much time as they wanted with the specialist."
(Arch Intern Med. 2004;164:1015-1020. Available post-embargo at archinternmed.com)
Editor's Note: This study was supported by the Primary Care Research and Education Fund of Brigham and Women's Hospital, Boston, Mass. Dr. Keating is a recipient of a Doris Duke Clinical Scientist Award.
Editorial: Trust – Can We Create the Time?
In an accompanying editorial, Joel S. Levine, M.D., of the University of Colorado Health Sciences Center, Denver, writes, "Beneficence, confidentiality, and compassion are tenets of our profession and qualities that engender trust. Most, if not all, physicians believe that developing trust with their patients is essential to good clinical outcomes. We are not surprised when research validates this precept by showing that patient understanding, satisfaction, and compliance are better when the patient trusts the physician."
Dr. Levine writes that the findings of Keating et al raise several questions, including "How much of this lack of trust [among black patients as reported by the researchers] relates to the content of the visit vs. previous medical and non-medical interactions with the white community? As we recognize those factors that improve trust, can a white physician improve trust among their black patients by consciously applying them? With the increasing numbers of international medical graduates practicing in the United States, is there a similar problem in their developing trust with patients born in America of any race? Will we ever be able to figure out effective ways to increase the proportion of black physicians in the United States? I do not believe we have validated answers for any of these questions."
Dr. Levine also notes that to implement tactics to improve patients' trust in their physicians, time is required. "The problem is that to get from 80 percent of patients to 'trust completely' to 95 percent (where I would like to be) requires time. I believe that the health 'system' we work in gives the physician providing cognitive services overwhelming financial disincentives to spend more time with patients."
"My personal bias is that for the foreseeable future the direct interaction of the patient with a thoughtful and caring physician has important value," writes Dr. Levine. "The time physicians spend in the management of their patients, all of their time, has value. We should have a health care system that provides appropriate financial incentives to achieve this better delivery system."
(Arch Intern Med. 2004;164:930-932. Available post-embargo at archinternmed.com)
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.
Journal
Archives of Internal Medicine