Shenolikar Rahul A, Balkrishnan Rajesh, Hall Mark A
Division of Management, Policy and Community Health, University of Texas School of Public Health, 1200 Herman Pressler, Houston, TX 77030, USA.
BMC Health Serv Res. 2004 Sep 7;4(1):24. doi: 10.1186/1472-6963-4-24.
Patients' trust in physicians and in the medical profession is vital for a successful patient-physician relationship. Trust is especially salient in critical medical situations, such as serious side-effects, hospitalizations, and diagnoses of serious medical conditions, but most trust studies have been done with the general population or in routine primary care settings. This study examines the association between patient-physician encounters in such critical medical situations and patients' trust in their physician and in the medical profession in general.
A random national telephone survey was conducted using validated multi-item questionnaire measuring trust and satisfaction with physicians and with the medical profession. A seven item questionnaire measured the patient-physician encounters in critical medical situations. A total of 1117 subjects aged 20 years and older with health insurance were included for analyses. Spearman rank order correlations were used to determine the association of encounter variables with trust in physicians and the medical profession.
Prescription of medications by primary care physicians that patients believed might have side effects was negatively correlated with trust in physician (rho = -0.12, p < 0.001, n = 1045) in multivariate analysis. A primary care physician evaluating the patient for a condition the patient believed was serious was positively correlated with trust in physician (rho= 0.08, p < 0.01). Being hospitalized was positively correlated with trust in the medical profession (rho = 0.12, p < 0.01, n = 475).
Hospitalization, perceived seriousness of condition, and concerns about the risks of medications were found to be associated with patient trust in physicians or the medical profession. These findings highlight the salience of trust in serious physician-patient encounters and the role that patient vulnerability plays in determining patient trust.
患者对医生及医疗行业的信任对于成功的医患关系至关重要。在诸如严重副作用、住院治疗以及严重疾病诊断等危急医疗状况下，信任尤为突出，但大多数信任研究是针对普通人群或在常规初级保健环境中进行的。本研究考察在这些危急医疗状况下医患接触与患者对其医生及整个医疗行业的信任之间的关联。
采用经过验证的多项目问卷进行全国随机电话调查，该问卷用于测量对医生及医疗行业的信任和满意度。一份包含七个项目的问卷测量了在危急医疗状况下的医患接触情况。共有1117名年龄在20岁及以上且有医疗保险的受试者纳入分析。采用Spearman等级相关分析来确定接触变量与对医生及医疗行业的信任之间的关联。
在多变量分析中，患者认为可能有副作用的初级保健医生所开药物与对医生的信任呈负相关（rho = -0.12，p < 0.001，n = 1045）。初级保健医生针对患者认为严重的病情对患者进行评估与对医生的信任呈正相关（rho = 0.08，p < 0.01）。住院与对医疗行业的信任呈正相关（rho = 0.12，p < 0.01，n = 475）。
研究发现，住院治疗、感知到的病情严重程度以及对药物风险的担忧与患者对医生或医疗行业的信任相关。这些发现凸显了在严重医患接触中信任的重要性以及患者脆弱性在决定患者信任方面所起的作用。
