Riewpaiboon Wachara, Chuengsatiansup Komatra, Gilson Lucy, Tangcharoensathien Viroj
Health System Research Institute, Ministry of Public Health, Tivanond Road, Nonthaburi 11000, Thailand.
Soc Sci Med. 2005 Oct;61(7):1408-17. doi: 10.1016/j.socscimed.2004.11.075. Epub 2005 Jan 25.
There is evidence to suggest the decline of trusting relationships in modern healthcare systems. The primary aim of this study was to investigate the role of trust in medical transactions in Thailand, using obstetric care as a tracer service. The paper proposes an explanatory framework of trust for further investigation in other healthcare settings. The study site was a 1300-bed tertiary public hospital in Bangkok which it provides two forms of obstetric care: regular obstetric practice (RP) and private obstetric practice (PP). Forty pregnant women were selected and interviewed using a set of guiding questions. A thematic analysis of the interviews was undertaken to generate understanding and develop an explanatory framework. It was found that patients' trust in obstetric services was influenced by their perceptions of risk and uncertainty in pregnancy and childbirth, and that these perceptions were linked to their social class. Social class also influenced the accessibility and affordability of care to patients. Middle class pregnant women with relatively high-level concerns about risk and uncertainty preferred using PP service as a means to achieve interpersonal trust. These women thought that an informal payment would provide the basis for interpersonal trust between themselves and the chosen obstetricians. In practice, however, obstetricians involved in PP rarely acknowledged this reciprocal relationship and hardly expressed the additional courtesy expected by patients. As a result, PP service only created an expensive impersonal trust that was mistaken as interpersonal trust by patients. Negative outcomes from PP often caused disappointment that could eventually lead to medical litigation. The study suggests that there are some negative impacts of PP within the health system. Negative experiences among PP users may undermine trust not only in the specific doctor but also trust in health professionals and hospitals more generally. Steps need to be undertaken to protect and strengthen existing impersonal trust, which combine institutional trust based on good governance and service quality with trust in the professional standard of practice. The explanatory framework developed through this study provides a foundation for further studies of trust in different specialties and care settings.
有证据表明现代医疗系统中信任关系在下降。本研究的主要目的是，以产科护理作为追踪服务，调查信任在泰国医疗交易中的作用。本文提出了一个信任的解释框架，以供在其他医疗环境中进一步研究。研究地点是曼谷一家拥有1300张床位的三级公立医院，该医院提供两种产科护理形式：常规产科服务（RP）和私立产科服务（PP）。选取了40名孕妇，使用一组指导性问题进行访谈。对访谈进行了主题分析，以增进理解并构建一个解释框架。研究发现，患者对产科服务的信任受其对怀孕和分娩风险及不确定性的认知影响，而这些认知与他们的社会阶层有关。社会阶层也影响了患者获得护理的可及性和可负担性。对风险和不确定性有较高担忧的中产阶级孕妇更倾向于选择私立产科服务，以此来建立人际信任。这些女性认为非正式付费将为她们与所选产科医生之间的人际信任奠定基础。然而，实际上，参与私立产科服务的产科医生很少承认这种互惠关系，也很少表现出患者所期望的额外礼遇。结果，私立产科服务只建立了一种昂贵的非人际信任，而患者却误以为是人际信任。私立产科服务带来的负面结果往往会导致失望，最终可能引发医疗诉讼。该研究表明，私立产科服务在医疗系统中存在一些负面影响。私立产科服务使用者的负面经历不仅可能破坏对特定医生的信任，还可能更广泛地破坏对医疗专业人员和医院的信任。需要采取措施来保护和加强现有的非人际信任，将基于良好治理和服务质量的机构信任与对专业执业标准的信任结合起来。通过本研究构建的解释框架为进一步研究不同专科和护理环境中的信任提供了基础。
