Earning trust and losing it: Adolescents’ views on trusting physicians

• 17-year-old female without chronic illness: “Like a doctor that gave you the wrong like…gave you a bad diagnosis or something and was, you know, had made a mistake, and they knew that they had made a mistake. You would naturally not go back to them.”
• 17-year-old female without chronic illness: “I think that you can get people to trust you and respect you and stuff by being efficient, professional, doing a job well and making it as painless as possible. Not necessarily, you know, talking to them about this that and the other thing.”

Honesty

Eight of the 12 groups identified honesty as an attribute of a good doctor and a trusted doctor. Adolescents defined an honest doctor as one who is realistic, accurate, and does not withhold information. For example,

• 15-year-old female with sickle-cell: “But I would like to know if I have bad news so I can, like, pump myself up to feel better. I don’t want them to come in to say ‘you’re feeling better, you’ll probably be out soon’, and then [find out I have something bad].”
• 12-year-old female with cystic fibrosis: “Yeah, if they lie to you, you kind of feel like you cannot trust them anymore.”
• 15-year-old female without chronic illness: “If there’s something’s wrong with you, you trust ’em to tell you.”

When asked if there were times when a doctor should not share bad news, all participants responded that the doctor should either share the news directly with the adolescent or with a parent, who would then discuss it with the adolescent. Access to all information was particularly important to participants with chronic illnesses, as demonstrated by this comment:

• 16-year-old female with cystic fibrosis: “I think it’s very important and if he didn’t, if my doctor didn’t [tell me the bad news], it could result in weeks of hospitalization. But my doctor does tell me the truth. I mean there’s hardly any time where he keeps something from me. I think the only way he’d keep something from me is if I wasn’t ready to hear it or if it really didn’t concern what I did just as long as my parents know about it.”

Global

Hall et al describe the global dimension of trust as serving 2 functions. The first is for comments that intersect 2 or more of the other areas but do not fit exclusively in one. The second is to capture the holistic quality of trust.

Group discussions about this global dimension involved a “friend-like” relationship with the doctor, comfort with the doctor, and an overall sense that the doctor could be trusted. The comments noted below are organized into these content areas:

• Friend-like.
• 14-year-old male with Crohn’s disease: “[The doctors] know their patient as a friend and not as a patient…they know them like a friendship and everything.”
• 16-year-old female without chronic illness: “[A good doctor] would be a friend with the patient, not just be an authority [figure].”

When asked how a doctor should relate to an adolescent patient as a friend, several adolescents suggested the doctor telling about his personal life (eg, family, children) and asking about the adolescent’s personal life (eg, sports, school). A 14-year-old male with Crohn’s disease suggested, “Have a conversation with them, not like question-answer, question-answer, having a conversation so it all flows.”

Comfort. Participants described physician use of introductory small talk as a means of building comfort, and the premature introduction of sensitive topics (eg, drug use, sexual behavior, family issues) as a barrier to comfort.

• 16-year-old female without chronic illness: “It’s sort of like an introductory question, like they’ll get you in there, try to make you feel comfortable, and they’re like,’ how’s school going’…I think they try to strike up a conversation to make you feel more comfortable.”
• 11-year-old female without chronic illness: “But if the doctor is a guy, then you probably won’t feel comfortable talking about that [peer pressure and menstrual cycles].”

Comfort was a prerequisite for trust for some adolescents. Participants described feeling comfortable telling their doctor and then trusting them with the information. The following comment illustrates the relationship:

• 15-year-old female without chronic illness: “If you’re comfortable, you have more trust in the person.”

Overall sense of trust. The older, healthy female group was the only group that described trust from a holistic perspective:

• MODERATOR: “I mean, what is it that makes them trustworthy? (Pause.) Just ‘cuz they’re doctors? Ok.”
• 17-year-old female without chronic illness: “I mean, you kinda want to trust your doctor and you don’t want to believe that they’re trying to get you…there’s nothing behind their back. You do want to be able to trust them.”