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November 18, 1998

Mediators of Patient Trust

Author Affiliations

From the Center for Health Policy, Leonard Davis Institute of Health Economics, School of Medicine, University of Pennsylvania, Philadelphia.

JAMA. 1998;280(19):1703-1704. doi:10.1001/jama.280.19.1703

Trust—a firm belief or confidence in the honesty, integrity, reliability, and justice of another person or thing1—is the critical foundation of an effective patient-physician relationship. Not long ago, trust was paramount; it certainly never was a problem for Marcus Welby. However, some of the tools that managed care has introduced to influence physician behavior toward efficient and high-quality medical care (although some critics doubt its commitment to the latter) have made evaluation of patient trust a legitimate scientific question. These managed care tools include rules (eg, mandatory clinical protocols, retrospective and prospective utilization review) and financial incentives (eg, various methods of payment).2