Primary Care Research

Patients are more trusting of doctors who spend more time with them and discuss the impact of their illness

Patients' trust in their physicians has been linked to patient satisfaction, adherence to treatment, continuity of care with the same physician, and improved health. A recent study supported by the Agency for Healthcare Research and Quality (HS10610) is the first to link trust to specific observable physician behaviors. It showed that exploring patients' experiences with their disease or illness and spending more time with patients during office visits increases patients' trust in their physicians.

Kevin Fiscella, M.D., M.P.H., of the University of Rochester School of Medicine and Dentistry, and his colleagues assessed physician behavior and length of office visits. They used audiotapes of visits of two unannounced standardized patients (SPs)—SPS are actors portraying patients with certain conditions—with 100 community-based primary care physicians participating in a large managed care organization. The researchers used three components of the Measure of Patient-Centered Communication (MPCC) scale to assess physician behavior during the taped SP visits. The Primary Care Assessment Survey (PCAS) trust subscale was also administered to 50 patients from each physician's practice and to the SPs.

Component 1 of the MPCC, doctors exploration of patients' experience of the disease and illness, was independently associated with patients' ratings of trust in their physicians. A 1 standard deviation (SD) increase in this score was associated with a 0.08 SD increase in trust. Each additional minute spent in SP visits was also independently associated with 0.01 SD increase in patient trust. Surprisingly, component 2, asking about a patient's family, job, etc., and component 3, explaining and involving the patient in discussion of the problem and management plan, did not affect trust.

See "Patient trust: Is it related to patient-centered behavior of primary care physicians?" by Kevin Fiscella, M.D., M.P.H., Sean Meldrum, M.S., Peter Franks, M.D., and others, in the November 2004 Medical Care 42(11), pp. 1049-1055.

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