Patient trust: is it related to patient-centered behavior of primary care physicians?
BACKGROUND
Patients' trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients.


METHODS
We assessed physician behavior and length of visit using audio tapes of encounters of 2 unannounced standardized patients (SPs) with 100 community-based primary care physicians participating in a large managed care organization. Physician behavior was assessed via 3 components of the Measure of Patient-Centered Communication (MPCC) scale. The Primary Care Assessment Survey (PCAS) trust subscale was administered to 50 patients from each physician's practice and to SPs. We used multilevel modeling to examine the associations between physicians' Patient-Centered Communication during the SP visits and ratings of trust by both patients and SPs.


RESULTS
Component 1 of the MPCC, which explored the patient's experience of the disease and illness, was independently associated with patient's rating of trust in their physician. A I SD increase in this score was associated with 0.08 SD increase in trust (95% confidence interval 0.02-0.14). Each additional minute spent in SP visits was also independently associated with 0.01 SD increase in patient trust. (95% confidence interval 0.0001-0.02). Component 1 and visit length were also positively associated with SP trust ratings.


CONCLUSIONS
Physician verbal behavior during an SP encounter is associated with trust reported by SPs and patients. Research is needed to determine whether interventions designed to enhance physicians' exploration patients' experiences of disease and illness improves trust. Key Words: physician-patient relationship, patient-centered care, trust, physician behavior
Fiscella
Kevin
K
Department of Family Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA. Kevin_Fiscella@urmc.rochester.edu
Meldrum
Sean
S
Franks
Peter
P
Shields
Cleveland G
CG
Duberstein
Paul
P
McDaniel
Susan H
SH
Epstein
Ronald M
RM
D000328:Adult; D017677:Age Distribution; D001291:Attitude of Health Personnel; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D035502:Trust