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Trust in Health Care
March 22, 2019

Why Physicians Should Trust in Patients

Author Affiliations
  • 1University of Wisconsin-Madison
  • 2National Patient Advocate Foundation, Washington, DC
  • 3Agency for Healthcare Research and Quality, Rockville, Maryland
JAMA. 2019;321(14):1347-1348. doi:10.1001/jama.2019.1500

Most of the existing literature on trust between patients and physicians focuses on whether patients trust their clinicians. When medical paternalism was the dominant model in health care, this focus may have been logical: if the physician knows best, the main role of patients is to trust and follow the guidance of physicians. But in the “new age of patient autonomy,”1 a growing, but still limited, evidence base demonstrates the efficacy of patient-physician partnerships and co-produced care to improve quality and safety of care, patient health outcomes, and patient experience. A 2017 National Academy of Medicine report highlighted the potential of shared decision making, advance care planning, and family involvement to improve health outcomes.2 Without intentional cultivation of these often-neglected aspects of patient-physician relationships, increasing reciprocal trust between patients and physicians—an important aspect of both quality of care and positive experiences with care for patients, families, and professionals—will remain an elusive goal.

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    3 Comments for this article
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    Trust. The Holy Grail of Medicine
    Edward Volpintesta, MD | Bethel Medical Group
    I know that when I trust a patient I have confidence that my suggestions will be followed, that follow-up appointments will be kept, and that if any problems arise I will be notified quicker rather than later. This is important particularly in conditions that require close monitoring like hypertension and diabetes.

    But trusting a patient takes time. With some, trust occurs at the first visit. With others it takes time. And with others it is difficult and trust is late in coming or never occurs completely.

    In those patients that I trust, a friendship develops that makes taking
    care of them a mutually enjoyable professional-social experience.
    CONFLICT OF INTEREST: None Reported
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    Excellent Viewpoint Article
    Scott Helmers, MD | Retired
    This essay is well worth reading by any practicing physician. The problem I see is that developing trust requires not only effort but time. As medicine has been taken over by corporate profit motivation, rather than individual doctors trying to help and care, how much time is allotted, especially beyond the time one's face is buried in the EHR?
    CONFLICT OF INTEREST: None Reported
    Trust and Health
    Paul Nelson, M.D., M.S. | Family Health Care, P.C. retired
    The ultimate attribute of trust is represented by its independent capability to improve a person's health and its subsequent healthcare. Otherwise, this is definable as "reverse causality." Having spent a few years looking for studies connecting trust, social capital and social cohesion, I found a study using data from the United Kingdom by a research team in Sweden (1). The report's conclusions begins with this sentence: "This study offers empirical evidence to support the circular nature of trust/health relationships."

    A second companion study was adapted for a study of Affordable Care Act outcomes 2006-2014
    (2). Its Abstract begins, "Previous research shows that generalized trust, the belief that most people can be trusted, is conducive to people's health."

    References

    1. Giordano GN, Linstrom M. J Epidemiol Community Health published online First 11-6-2015
    http://dx.doi.org/10.1136/ech-2015-205822

    2. Mewes J, Giordano GN. Social Science & Medicine published online First 8-18-2017
    http://dx.doi.org/10.1016/j.socscimed.2017.08.012
    CONFLICT OF INTEREST: None Reported
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