HealthSeptember 18, 2023

The importance of building trust in the physician-patient relationship

Trust. It's at the heart of every physician-patient relationship. The moment you walk into the examination room, your skills and education are put to the test as your patient is relying on your expertise and guidance to restore their health. More than just medical degrees hanging up on the wall, it is your conduct and commitment to the AMA code of medical ethics to “regard responsibility to the patient as paramount” that creates an atmosphere of comfort and assurance.

As a physician, your commitment to making ethical decisions based on your patients' best interest is one of the fundamental elements in establishing and maintaining trust. While it's true that the health care industry seeks to make profit just like any other, being an advocate for your patients' health always takes priority. As employer demands grow, it is becoming increasingly more important to manage personal and professional conflicts of interest.

Conflicts of interest between physicians and patients

It is no secret that being a physician can be a very lucrative career path, but it's not a common reason why many choose to go to medical school. According to a survey conducted of what drove physicians across the U.S. to pursue medicine posted by St. George's University School of Medicine, some of the top reasons include:

  1. To save lives in unexpected emergencies
  2. To empower patients to take control of their health
  3. To play a critical role in a growing field

Unfortunately, financial incentives for physicians are still a concern for patients. According to a Report of the Council on Ethical and Judicial Affairs*, in the era of managed care some of the risk-bearing arrangements that may benefit physicians may also be harmful to patients. Incentives for a job well done are not inherently wrong, but often put physicians in a difficult position.

In Opinion 8.054, it is recommended that large financial incentives should be limited in order to prevent physicians' personal financial concerns from creating a conflict with their role as individual patient advocates.

Patient trust in the U.S. health care system

While the physician-patient relationship is paramount to one's individual health, how they feel about the health care industry in general may affect whether they even pick up the phone to make an appointment. In 2021, the American Board of Internal Medicine Foundation (ABIM) commissioned NORC at the University of Chicago to conduct surveys of trust in the U.S. health care system among the public and physicians. One of the key findings showed that the public has greater trust in physicians than they do in the health care system as a whole (64% completely/somewhat trust).

Another discovery showed that physicians understand the importance of building trust with their patients, but do not always engage in trust-building behaviors. While the survey broke down some interesting statistics regarding race, gender, age, and income, another key finding of the survey showed that trust in health care starts with building trust in the physician-patient relationship.

What drives patient mistrust in their physicians?

When patients were asked in the above-mentioned survey why they do not trust their doctor, 25% said their doctor doesn't spend enough time with them. A similar response of 14% said their doctor does not know them or listen to them.

When patients were asked why they do not trust their doctor, here is what they said:

Knowing the demands of their employers and busy schedules, physicians seem to be aware of and agree with 27% believing poor communication as being the number one contributing factor to patient mistrust. It’s clear that the ever-changing health care system and expansion of managed care is having a significant impact on the ideal physician-patient relationship. Adapting to any type of change to a business is hard enough but add in a global pandemic of a brand-new virus and your role as a trusted physician has never been more important.

How to rebuild patient trust in health care

So, what is your role when it comes to improving your relationship with your patients? According to Dr. Rich Baron, MD, president, and CEO of the American Board of Internal Medicine and ABIM Foundation, you should organize your work building trust around five C's, C's being Caring, Comfort, Competency, Communication and Cost.

Paying attention to those things in a comprehensive way can help organizations organize activities in ways that are likely to build trust. And each of us, we know in our day-to-day clinical opportunities, we have opportunities to build in all of those. They're all opportunities where we can do better.

Rich Baron, MD

When trust is established, open communication between a patient and their physician can occur leading to the most effective diagnosis, treatment, and ongoing care. Listen and learn how Encouraging Conversations Between Physicians and Patients to Improve Urgent Care.

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