Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study.
BACKGROUND
New patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Persons with HIV infection may be an ideal population to study the drivers of a positive initial patient-provider relationship, as it is a chronic and serious condition that requires a reliable, ongoing relationship with a provider. Informed by patients' real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset.


METHODS
We conducted longitudinal, in-person interviews with 21 patients new to the HIV clinic at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, from August 2013 to March 2015. Patients were interviewed across three time points: once before their first provider visit, a second time within two weeks after the first visit, and a third time at 6 to 12 months after the first provider visit.


RESULTS
We conducted 61 h of patient interviews. The mean age was 53 years; 52% were non-Hispanic white, 23% were non-Hispanic black and 19% were Hispanic. Patients described significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider. Our analysis of these experiences revealed five actions providers can take to reduce their patients' anxiety and build trust early in the first visit: 1) provide reassurance to patients, 2) tell patients it's okay to ask questions, 3) show patients their lab results and explain what they mean, 4) avoid language and behaviors that are judgmental of patients, and 5) ask patients what they want [i.e., treatment goals and preferences].


CONCLUSIONS
Our study incorporates direct input from patients and highlights the unique psychological challenges that patients face in seeking care from a new provider. The actionable opportunities cited by patients have the potential to mitigate patients' feelings of anxiety and vulnerability, and thereby improve their overall health care experience.
VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA. bndang@bcm.edu.|Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX, 77030, USA. bndang@bcm.edu.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA. bndang@bcm.edu.
Bich N
BN
Dang
Jesse H. Jones Graduate School of Business, Rice University, Houston, TX, USA.
Robert A
RA
Westbrook
VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA.|Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Sarah M
SM
Njue
VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA.|Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Thomas P
TP
Giordano
D001007:Anxiety; D003142:Communication; D015658:HIV Infections / Q000523:psychology*; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D013781:Texas; D035502:Trust
HIV infection; Health communication; Longitudinal studies; Patient engagement; Patient preference; Patient satisfaction; Patient-centered care; Physician-patient relations; Qualitative studies; Retention in care