Trust: The keystone of the physician-patient relationship | The Bulletin
Trust is the basis for a productive physician-patient according to Dr. It is my advice to you that in your interactions with patients, always keep. PDF | Apart from the fact that trust between doctors and patients is a source of model of trust in the doctor-patient relationship based on . of trust to emerge, so that the patient can fully benefit from doctor's advice, or make changes. in his or .. Institutional trust in the doctor-patient relationship is built and maintained in the. Relationships with patients can pose a challenge to doctors at any point in their The specialty that doctors work in can affect their ability to maintain Bristol NHS Trust, has built relationships with patients and become friends Trainees should ask for advice from their educational supervisor, she says.
Patients may feel like they are objects being discussed, rather than as equals participating in their own care; they may not feel as though they know all of the team members and what their roles are Trust: There may be too many people with whom to establish rapport Knowledge and regard: Whenever possible, limit the number of physicians who round on a patient at one time; in teaching hospitals, where this is not always possible, team members should introduce themselves to the patient outside of rounds to establish rapport and to know the patient Urgent care setting eg, emergency department, clinic Knowledge: The doctor and the patient may not know each other Knowledge: The patient and the physician may be less inclined to invest effort in establishing rapport if they know they will not see each other again Regard: Take the time to establish rapport and to make the patient feel comfortable whenever possible Loyalty: Clinics may not be set up for longitudinal care eg, in the emergency department Loyalty: Set up follow-up appointments with established providers before discharging the patient Cost Regard: The patient may harbor resentment about medical bills Knowledge: The patient may be reluctant to see a doctor due to financial concerns Documentation burden Knowledge: Physicians may spend much of the visit making sure all the necessary computer boxes are checked rather than getting to know the patient as a person; having a computer between the patient and the doctor also makes it hard for the patient to feel like he or she knows the doctor Several time-saving strategies can be employed to reduce the amount of time spent on documentation and increase the time available for physicians to spend with patients Embrace technology: Physicians may spend much of the visit facing the computer screen rather than the patient, which may make the patient feel as though the doctor does not care about him or her as a person; the amount of paperwork and documentation that is often required also enhances physician burnout, making it harder for the physician to demonstrate empathy and caring Use dictation software to speed note-writing When appropriate, write a note collaboratively with the patient during the visit; if using this approach, either turn the screen so that the patient can see it as well or arrange seats so that the physician can maintain eye contact with the patient while he or she is typing the notes aRefers specifically to teaching rounds, wherein a large team of providers visits a patient as a group.
Attentive doctors are better able to understand both verbal and nonverbal communication 28 ; therefore, burnout, which hinders attentiveness, prevents physicians from appreciating the needs of their patients, thus failing to identify their ailments Regard: It is harder for emotionally exhausted physicians to show affection; when physicians are burned out, their patients are more likely to report that physicians use nonempathic statements 26 Loyalty: Patients are less likely to return to a physician who fails to recognize their needs or who fails to regard them as individuals Doctors in training or in early career Trust: Take the time to explain your clinical reasoning to a patient to demonstrate competence Loyalty: Get to know your patient Regard: Demonstrate caring for your patient Conflict on or with the treatment team Trust: Use structured communication formats and regularly scheduled care-team meetings to improve teamwork 33 ; include teamwork instruction as part of general medical education 34 Knowledge: Physicians may be distracted by team conflict and be unable to focus on the patient and his or her problem; doctors may displace frustration with the team onto the patient.
Swasey in her thesis mentions that in this first interaction, doctors can use open-ended question to guide the conversation in-order to get appropriate information needed for proper diagnosis and management.
Studies have shown that trust is closely related and somewhat influenced by the health care providers' communication skills [ 6222533 ]. There has been a shift from the problem focused communication to solution focused communication which is evident to the lay people as well [ 34 ]. A study was conducted by Butalid et al. The mixed methodology type was used for the analogue patients with hypertension to assess the videotaped consultation between 2 periods; in s and in s.
The study found that participants recognize listening, giving support and showing respect were consistent themes in both the time periods. The authors concluded that aspects of the medical interaction that patients value are evidence-based medicine and attention to the process of shared decision making.
Studies have demonstrated patient discontent even when many doctors considered the communication adequate or even excellent [ 36 ]. Currently, there is a greater expectation of collaborative decision making. Physicians and patients participate as partners to achieve the agreed upon goals and the attainment of quality of life [ 7 ]. Trust, communication and patient satisfaction Studies have shown that patient satisfaction is positively correlated with communication skills [ 37 ].
This included patients willing to participate, spoke English, first admission within the study period and those who completed their 1-month follow-up questionnaire. Small changes in doctor communication behaviors can make some significant changes in patient satisfaction [ 36 ]. Similar findings were noted in another study [ 31 ]. The study concluded that doctors should be having regular workshops to improve their communication skills.
Although, interpersonal-based medical service encounter directly affects patient satisfaction, patient trust is used as intervening variable to affect patient satisfaction, which represents an indirect effect [ 37 ]. They conducted a cross-sectional study using a questionnaire in seven medical centers of Taiwan.
Participants were recruited under volunteer basis; from a total of participants, valid copies were retrieved. Hospitals are recommended to enhance professional skills and communication, attitudes of personnel to build adequate trust and retain patients [ 38 ]. When it comes to patients with chronic disease, trust and communication carry the same value in their satisfaction with the care provided.
There is a need for doctors to develop good interpersonal and communicating skills in-order to have an effective and quality doctor-patient interaction with their diabetic patients. For all the patients attending public diabetic clinic in the province of Punjab in Pakistan, 1, patients who were 18 years over, had diabetes and made at least three previous visits to the same clinic were included in the study.
The Importance of Healthy Doctor-Patient Relationships
Qualitative analysis also showed that communication and approachability was linked to the doctor - patient interaction. This study concluded that patient dissatisfaction was related to inadequate medical interaction with the patients. Empowering the patients, training the medical staffs on proper interactions and doing regular patient satisfaction surveys will contribute to increase in quality of doctor-patient interaction [ 39 ].
Patients with higher trust in their physician usually have more beneficial health behaviours, less symptoms, higher quality of like and were more satisfied with the treatment. Healthcare providers, especially doctors, must convince their patients to share personal information, submit to tests and take chemicals in the form of medication in their body [ 25 ].
Trust plays a vital role to get all this done. A meta-analysis was conducted by Birkhauer et al. They synthesized 47 full text, peer-reviewed articles which were relevant to their objective. Extracted data were analyzed using correlation. The authors suggested further prospective studies need to be done to further knowledge on impact of trust on health outcome.
Patient satisfaction, which is influenced by trust is an important indicator to know the quality of the hospital and clinical services provided. Studies have shown a strong correlation between patient satisfaction and quality, including safety of health care [ 91112 ].
Their review showed that improved patient satisfaction was associated with increased levels of adherence to treatment processes and recommended prevention, improved clinical outcomes, better patient safety within hospitals and less health care utilization [ 9 ]. Hence, conducting patient satisfaction surveys using standard protocols and appropriate methods are appropriate complements for clinical process and outcome measures in healthcare facilities. It can serve as an indicator of the actual quality of the care they receive [ 10 ].
They used the Hospital Consumer Assessment of Healthcare Providers and Systems survey data from and to assess performance on patient experience in US hospitals. Hospitals with the highest level of patient satisfaction had a shorter length of stay 7.
This US study showed that hospitals with high patient satisfaction provided more efficient care and were associated with higher surgical quality [ 10 ].
Even though, trust in a doctor-patient relationship has advantages such as avoiding unnecessary outrage due to inferior performance, Hall et al. Overall, it is important to for individual health care facilities to carry out their patient satisfaction surveys to facilitate strategy formulation of effective and efficient quality of health care services and better patient outcomes.
Conclusion The current literature illustrates the importance of trust and communication in a doctor-patient relationship for a better and effective treatment given to the patients. Trust is something that must be built and gained and having good communication skills, assists in building this trust between a doctor and patient.
The evidence shows that trust and communication with a patient - centered approach has contributed to improved patient outcomes with patients being satisfied with the services they were offered at the health facility. This is associated with better adherence to the treatment and better perceived quality of health care services.
The importance of trust and communication in a doctor -patient relationship carry the same importance for both developed and developing countries in terms of patient satisfaction and quality of health care services, though the determinants may differ slightly.
Conducting regular patient satisfaction surveys and further research on this topic will help health facilities to evaluate their services and help with strategic planning to better their services. References Levy S How has the physician-patient relationship changed? Future prospects and the research agenda. J Med Internet Res 3: Values, autonomy, and medical information in the patient-centered clinical encounter.
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The Importance of Healthy Doctor-Patient Relationships
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Trust: The keystone of the physician-patient relationship
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