title: Patient characteristics and experiences associated with trust in specialist physicians.
abstract: BACKGROUND
  Nearly half of all medical visits are to specialist physicians, yet little is known about patients' outpatient experiences with specialists or how patients' characteristics and experiences are related to trust in specialist physicians.
  
  
  METHODS
  We surveyed patients who had a new patient visit with a cardiologist, neurologist, nephrologist, gastroenterologist, or rheumatologist practicing in hospital-based practices (response rate, 73%; N = 417) and inquired about their experiences with care and trust in the specialist physician. We used multivariable models to assess associations of patients' characteristics and experiences with trust.
  
  
  RESULTS
  Most patients reported good experiences, and 79% reported complete confidence and trust in the specialist. Black patients were less trusting than white patients (risk ratio [RR], 0.5; 95% confidence interval [CI], 0.2-0.8). Patients were more trusting if they reported that the consultant listened (RR, 1.8; 95% CI, 1.0-2.5), received as much information as they wanted (RR, 1.6; 95% CI, 1.1-1.9), were told what to do if problems or symptoms continued, got worse, or returned (RR, 1.4; 95% CI, 1.2-1.5), were involved in decisions as much as they wanted (RR, 1.5; 95% CI, 1.2-1.8), and spent as much time as they wanted with the specialist (RR, 1.8; 95% CI, 1.3-2.2).
  
  
  CONCLUSIONS
  Patients reported high levels of trust in specialist physicians after an initial visit. Several specific experiences were associated with higher trust, suggesting that efforts to improve patient-physician interactions may be successful at achieving trust. Such efforts should especially aim to optimize physicians' interactions with black patients, who were less trusting of specialist physicians.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. keating@hcp.med.harvard.edu
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Tejal K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D006801:Humans; D008875:Middle Aged; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D013038:Specialization; D035502:Trust