Mechanic D
Rutgers University, USA.
J Health Polit Policy Law. 1998 Aug;23(4):661-86. doi: 10.1215/03616878-23-4-661.
Trust, the expectation that institutions and professionals will act in one's interests, contributes to the effectiveness of medical care. With the rapid privatization of medical care and the growth of managed care, trust may be diminished. Five important aspects of trust are examined: technical and interpersonal competence, physician agency, physician control, confidentiality, and open communication and disclosure. In each case, changing health care arrangements increase the risks of trusting and encourage regulatory interventions that substitute for some aspects of trust. With the increased size and centralization of health care plans, inevitable errors are attributed to health plans rather than to failures of individual judgment. Such generalized criticisms exacerbate distrust and encourage micromanagement of medical care processes.
信任，即对机构和专业人员会为自身利益行事的期望，有助于提高医疗保健的有效性。随着医疗保健的迅速私有化和管理式医疗的发展，信任可能会减少。本文探讨了信任的五个重要方面：技术和人际能力、医生的行为、医生的控制权、保密性以及开放沟通与信息披露。在每种情况下，不断变化的医疗保健安排增加了信任的风险，并促使监管干预措施取代信任的某些方面。随着医疗保健计划规模的扩大和集中化，不可避免的错误被归咎于医疗保健计划，而不是个人判断失误。这种普遍的批评加剧了不信任，并促使对医疗保健过程进行微观管理。
