title: "You don't want to lose that trust that you've built with this patient...": (dis)trust, medical tourism, and the Canadian family physician-patient relationship.
abstract: BACKGROUND
  Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship-a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medical tourism on the therapeutic relationship.
  
  
  METHODS
  We conducted six focus groups with 22 family physicians in the Canadian province of British Columbia. Data were analyzed thematically using deductive and inductive codes that captured key concepts across the narratives of participants.
  
  
  RESULTS
  Family physicians indicated that they trust their patients to act as the lead decision-makers about medical tourism, but are conflicted when the information they are managing contradicts the best interests of the patients. They reported that patients distrust local health care systems when they experience insufficiencies in access to care and that this can prompt patients to consider going abroad for care. Trust fractures in the physician-patient relationship can arise from shame, fear and secrecy about medical tourism.
  
  
  CONCLUSIONS
  Family physicians face diverse tensions about medical tourism as they must balance their roles in: (1) providing information about medical tourism within a context of information deficits; (2) supporting decision-making while distancing themselves from patients' decisions to engage in medical tourism; and (3) acting both as agents of the patient and of the domestic health care system. These tensions highlight the ongoing need for reliable third-party informational resources about medical tourism and the development of responsive policy.
authors.affiliation: Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 4X9, Canada. crooks@sfu.ca.
authors.forename: Valorie A
authors.initials: VA
authors.lastname: Crooks
authors.affiliation: Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 4X9, Canada. kamingl@sfu.ca.
authors.forename: Neville
authors.initials: N
authors.lastname: Li
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 4X9, Canada. jeremycsnyder@sfu.ca.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Snyder
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. shafik.dharamsi@familymed.ubc.ca.
authors.forename: Shafik
authors.initials: S
authors.lastname: Dharamsi
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. shelly.benjaminy@ubc.ca.
authors.forename: Shelly
authors.initials: S
authors.lastname: Benjaminy
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. k.jacob@alumni.ubc.ca.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Jacob
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. jilles@mail.ubc.ca.
authors.forename: Judy
authors.initials: J
authors.lastname: Illes
mesh_terms: D001291:Attitude of Health Personnel; D001955:British Columbia; D003657:Decision Making; D017144:Focus Groups; D006801:Humans; D057193:Medical Tourism; D010817:Physician-Patient Relations; D010821:Physicians, Family; D035502:Trust