Trust and vulnerability in doctor-patient relations in occupational health.
BACKGROUND
The effectiveness of health care intervention depends heavily on the extent to which people trust the health care professionals with whom they come into contact. Therefore, to ensure effective health care, it is important to establish what factors influence patient perceptions of the trustworthiness of health care professionals.


OBJECTIVE
To explore the relation between trust and vulnerability in the occupational doctor-patient relationship by considering two opposing hypotheses on factors influencing perceptions of trustworthiness.


METHODS
An explorative, cross-sectional study design in which trust and vulnerability were measured quantitatively (questionnaire) as well as qualitatively (semi-structured interview) in a stratified sample (N = 68; response rate 24%).


RESULTS
The 'urgency' or threat of vulnerability (current reported poor health, high workload and high absenteeism) was found to be important in explaining the relationship between trust and vulnerability. The first hypothesis of vulnerability leading to lower level trust appeared only to apply to patients with good health and low workload. Although trust levels were higher among patients with poor health and high workload, the second hypothesis (the more vulnerable, the higher the trust level) could not be confirmed for highly vulnerable patients because distrust was hard to overcome if physicians' independency, agency or expertise was questioned.


CONCLUSIONS
Trust and the need for trust vary with the character and severity of ill health. Studies on trust in doctor-patient relationships are more worthwhile if they are directed at specific groups and situations.
Department of Public and Occupational Health, VU University Medical Centre, Van der Boechorststraat 7, Amsterdam 1081BT, The Netherlands. hn.plomp@vumc.nl
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Ballast
D001294:Attitude to Health; D002648:Child; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009426:Netherlands; D009786:Occupational Health Services; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011582:Psychological Theory; D036301:Qualitative Research; D012720:Severity of Illness Index; D035502:Trust / Q000523:psychology*; D035862:Vulnerable Populations / Q000523:psychology*; D016526:Workload / Q000523:psychology