Patients’ trust in their physicians
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
OBJECTIVE: To evaluate the extent to which physician choice, length of patient-physician relationship, and perceived physician payment method predict patients’ trust in their physician.
DESIGN: Survey of patients of physicians in Atlanta, Georgia.
PATIENTS: Subjects were 292 patients aged 18 years and older.
MEASUREMENTS AND MAIN RESULTS: Scale of patients’ trust in their physician was the main outcome measure. Most patients completely trusted their physicians “to put their needs above all other considerations” (69%). Patients who reported having enough choice of physician (p<.05), a longer relationship with the physician (p<.001), and who trusted their managed care organization (p<.001) were more likely to trust their physician. Approximately two thirds of all respondents did not know the method by which their physician was paid. The majority of patients believed paying a physician each time a test is done rather than a fixed monthly amount would not affect their care (72.4%). However, 40.5% of all respondents believed paying a physician more for ordering fewer than the average number of tests would make their care worse. Of these patients, 53.3% would accept higher copayments to obtain necessary medical tests.
CONCLUSIONS: Patients’ trust in their physician is related to having a choice of physicians, having a longer relationship with their physician, and trusting their managed care organization. Most patients are unaware of their physician’s payment method, but many are concerned about payment methods that might discourage medical use.
- Beauchamp T, Childless J. Principles of Biomedical Ethics. 3rd ed. New York, NY: Oxford University Press; 1989.
- Katz J. The Silent World of Doctor and Patient. New York, NY: Free Press; 1984.
- Macklin R. Enemies of Patients. New York, NY: Oxford University Press; 1993.
- Rodwin M. Medicine, Money and Morals. New York, NY: Oxford University Press; 1993.
- Emanuel EJ, Dubler NN. Preserving the physician-patient relationship in the era of managed care. JAMA. 1995;273:323–9. CrossRef
- Barber B. The Logic and Limits of Trust. New Brunswick, NJ: Rutgers University Press; 1983.
- Gambetta D, ed. Trust: Making and Breaking Cooperative Relations. New York, NY: Blackwell; 1988.
- Kramer RM, Tyler TR, eds. Trust in Organizations: Frontiers of Theory and Research. Thousand Oaks, Calif: Sage; 1996.
- Mechanic D. Changing medical organization and the erosion of trust. Milbank Q. 1996;74:171–89. CrossRef
- Blendon RJ, Knox RA, Brodie M, Benson JM, Chervinsky G. Americans compare managed care, Medicare, and fee-for-service. J Am Health Policy. 1994;4:42–7.
- Hoerger TJ, Howard LZ. Search behavior and choice of physician in the market for prental care. Med Care. 1995;33:332–49. CrossRef
- Mechanic D, Ettel T, Davis D. Choosing among health insurance options: a study of new employees. Inquiry. 1990;27:14–23.
- Mitchell JH, Dunn JP. Employee’s choice of a health plan and their subsequent satisfaction. J Occup Med. 1984;26:361–6. CrossRef
- Hillman AL, Pauly MV, Kerstein JJ. How do payment methods affect physicians’ clinical decisions and the financial performance of health maintenance organizations? N Engl J Med. 1989;321:86–92. CrossRef
- Hillman AL. The impact of physician payment methods on high-risk populations in managed care. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8(Suppl 1):S23–30.
- Sulmasy DP. Physicians, cost control, and ethics. Ann Intern Med. 1992;116:920–6.
- Anderson LA, Dedrick RF. Development of the trust in physician scale: a measure to assess trust in patient-physician relationships. Psychol Rep. 1990;67:1091–100. CrossRef
- Kanter DL, Mirvis PH. The Cynical Americans: Living and Working in an Age of Discontent and Disillusion. San Francisco, Calif: Jossey-Bass; 1989.
- Janoff-Bulman R. Assumptive worlds and the stress of traumatic events: applications of the schema construct. Soc Cognition. 1993;7:113–36.
- Coleman PG, Shellow RA. Privacy and autonomy in the physician-patient relationship: independent contracting under Medicare and implications for expansion into managed care. J Leg Med. 1995;16:509–43.
- Wennberg JE. Health care reform and professionalism. Inquiry. 1994;31:296–302.
- Sederer LI, Mirin SM. The impact of managed care on clinical practice. Psychiatr Q. 1994;65:177–88. CrossRef
- Dubler NN. Individual advocacy as a governing principle. J Case Manage. 1992;1:82–6.
- Rosenthal TC, Teimenschneider TA, Feather J. Preserving the patient referral process in the managed care environment. Am J Med. 1996;100:338–43. CrossRef
- Korcok M. Capitation begins to transform the face of American medicine. Can Med Assoc J. 1996;154:688–91.
- Flynn MB. Power, professionalism, and patient advocacy. Am J Surg. 1995;170:407–9. CrossRef
- Apple GJ. Who bears the risk when physicians are also insurers? Minn Med. 1995;78:23–7.
- Clouthier M. The evolution of managed care. Trends Health Care Law Ethics. 1995;10:67–72.
- Solberg LI, Isham G, Kottke TE, et al. Competing HMOs collaborate to improve preventive services. Jt J Qual Improv. 1995;21:600–10.
- Morrow RW, Gooding AD, Clark C. Improving physicians’ preventive health care behavior through peer review and payment methods. Arch Fam Med. 1995;4:165–9. CrossRef
- Robinson JA, Robinson KJ, Lewis DJ. Balancing quality of care and cost-effectiveness through case management. Anna J. 1992;19:182–8.
- Angell M. The doctor as double agent. Kennedy Inst J Ethics. 1993;3:279–86.
- Orentlicher D. Managed care and the threat to the patient-physician relationship. Trends Health Care Law Ethics. 1995;101:19–24.
- Swee DE. Health care system reform and the changing physician-patient relationship. N J Med. 1995;92:313–7.
- Rodwin MA. Conflicts in managed care. N Engl J Med. 1995;332:604–7. CrossRef
- Nelms CR Jr. Ethical physicians cannot serve two masters. Minn Med. 1994;77:51.
- Lipset SM, Schneider W. The Confidence Gap: Business, Labor, and Government in the Public Mind. New York, NY: Free Press; 1983.
- Sheppard BH, Lewicki RJ, Minton JW. Organization Justice: The Search for Fairness in the Workplace. Lexington, Mass: Lexington Books; 1992.
- Gray BH. Trust and trustworthy care in the managed care era. Health Affairs. 1997;16:34–49. CrossRef
- Duck S, Perlman D, eds. Understanding Personal Relationships. Beverly Hills, Calif: Sage; 1985.
- National Survey of Employer-Sponsored Health Plans. New York, NY: Foster Higgins; 1996.
- Group Health Association of America/American Medical Care and Review Association Managed Health Care Directory. Washington, DC: AMCRA; 1995.
- Mechanic D, Schlesinger M. The impact of managed care on patients’ trust in medical care and their physicians. JAMA. 1996;275:1693–7. CrossRef
- Montague J. Managed care is dumping many physicians, but some aren’t going to take it lying down. Striking back. Hosp Health Netw. 1994;68:38–44.
- Bailey CW Jr. How to avoid being dropped from managed care plans. Postgrad Med. 1994;95:59–62.
- Guglielmo WJ. How to avoid deselection. Med Econ. 1996;73:149–54.
- Graddy B. TMA takes aim against deselection. Tex Med. 1994;90:14–47.
- Ortolon K. Deselection, round two: TMA takes due process with managed care organizations to US Congress. Tex Med. 1994;90:20–2.
- Brouillette JN. Bilateral deselection. J Fla Med Assoc. 1995;82:423.
- Morreim EH. Economic disclosure and economic advocacy. New duties in the medical standard of care. J Leg Med. 1991;12:275–329. CrossRef
- Patients’ trust in their physicians
Journal of General Internal Medicine
Volume 13, Issue 10 , pp 681-686
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patients’ trust
- choice of physician
- patient-physician relationship
- physician payment method
- Industry Sectors
- Author Affiliations
- 1. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., 02115, Boston, MA
- 2. the Prudential Center for Health Care Research, Atlanta, Ga.