title: A preliminary mixed-method investigation of trust and hidden signals in medical consultations.
abstract: BACKGROUND
  Several factors influence patients' trust, and trust influences the doctor-patient relationship. Recent literature has investigated the quality of the personal relationship and its dynamics by considering the role of communication and the elements that influence trust giving in the frame of general practitioner (GP) consultations.
  
  
  OBJECTIVE
  We analysed certain aspects of the interaction between patients and GPs to understand trust formation and maintenance by focusing on communication channels. The impact of socio-demographic variables in trust relationships was also evaluated.
  
  
  METHODS
  A cross-sectional design using concurrent mixed qualitative and quantitative research methods was employed. One hundred adults were involved in a semi-structured interview composed of both qualitative and quantitative items for descriptive and exploratory purposes. The study was conducted in six community-based departments adjacent to primary care clinics in Trento, Italy.
  
  
  RESULTS
  The findings revealed that patients trusted their GP to a high extent by relying on simple signals that were based on the quality of the one-to-one communication and on behavioural and relational patterns. Patients inferred the ability of their GP by adopting simple heuristics based mainly on the so-called social "honest signals" rather than on content-dependent features. Furthermore, socio-demographic variables affected trust: less literate and elderly people tended to trust more.
  
  
  CONCLUSIONS
  This study is unique in attempting to explore the role of simple signals in trust relationships within medical consultation: people shape trust and give meaning to their relationships through a powerful channel of communication that orbits not around words but around social relations. The findings have implications for both clinicians and researchers. For doctors, these results suggest a way of thinking about encounters with patients. For researchers, the findings underline the importance of analysing some new key factors around trust for future investigations in medical practice and education.
authors.affiliation: Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Riva
authors.affiliation: IBM Italia, Milan, Italy; Università Vita e Salute San Raffaele, Milan, Italy; Department for Adaptive Behaviour and Cognition, Max Planck Institute for Human Development, Berlin, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Monti
authors.affiliation: Department of Psychology, Università Cattolica del S. Cuore, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Iannello
authors.affiliation: Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; Psycho-Oncology Unit, Istituto Europeo Oncologico (IEO), Milan, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pravettoni
authors.affiliation: Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schulz
authors.affiliation: Department of Psychology, Università Cattolica del S. Cuore, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonietti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012017:Referral and Consultation; D012307:Risk Factors; D011795:Surveys and Questionnaires; D035502:Trust; D055815:Young Adult