How patients’ trust relates to their involvement in medical care
Trust in the medical profession is associated with greater willingness to seek care and follow recommendations
TABLE 5
P-values for significant predictors in the multivariate analysis
| FOLLOW PHYSICIAN’S RECOMMENDATION | RELY ON PHYSICIAN’S JUDGMENT | SEEK PROFESSIONAL HELP | PHYSICIAN CONTROL | PASSIVE ROLE | |
|---|---|---|---|---|---|
| Trust in physician | NS | NS | NS | NS | NS |
| Trust in medical profession | <.001 | <.001 | .010 | <.001 | .001 |
| Satisfaction with care | .003 | NS | NS | NS | NS |
| Sex | NS | .007 | NS | NS | NS |
| Age | NS | NS | NS | .001 | .002 |
| Education | NS | .015 | NS | .003 | .001 |
| Physical health | NS | NS | .047 | NS | NS |
| No. of physician visits | NS | NS | NS | NS | NS |
| No. of years with physician | NS | NS | NS | .033 | NS |
| Past dispute | NS | NS | NS | NS | NS |
| R 2 | 0.243 | ** | ** | 0.143 | 0.124 |
| * NS=not significant | |||||
| ** R2is not defined for logistic regression. | |||||
Discussion
What predicts involvement in medical care?
Trust a key predictor. Trust in the medical profession is a key predictor of people’s involvement in medical care. It is a significant predictor of self reports of: 1) following physicians’ treatment recommendations, willingness to 2) seek care and to 3) rely on physicians’ judgment, and wanting to 4) give physicians more control and 5) let them make decisions for patients. Most other relationship factors (trust in a specific physician, length and continuity of treatment relationship, past dispute with physician) predict fewer of these variables and are no longer significant in multivariate analyses. In bivariate analyses, satisfaction with care is also a consistent predictor of all 5 measures of involvement in medical care, but it usually no longer remains significant in regression analyses once trust in the medical profession is added to the models.
Demographics not significant. Similarly, demographic characteristics such as age, sex, or education often are no longer significant in regression models that control for trust in the medical profession, suggesting that, in some instances, these factors may influence views about involvement through their effect on trust in the medical profession.
Patient roles and control of medical care.
In general, increased trust in the medical profession is associated with a more deferential patient role in medical relationships. Higher trust is associated with greater willingness to give control to physicians and allow them to make decisions for the patient. However, other aspects of patient involvement are not as easily classified as deferential in the sense of the term that connotes a passive patient role. Trust in the medical profession is also associated with greater willingness to seek care and to comply with treatment recommendations.
To the extent that trust is associated with deferential or passive patient roles, it is notable that this association exists primarily only with the measures that refer to the medical system as a whole (including satisfaction with care generally), and not with the measures that are specific to particular physicians. The latter include trust in the patient’s personal physician, past disputes with that physician, number of visits with that physician, and length of relationship with that physician. Each of these is much less predictive of patients’ involvement in medical care than is trust in the medical profession or satisfaction with care generally.
What does this say about patient relationships in general?
This suggests, consistent with prior research,18,22 that patients’ views about particular physicians are substantially (but not entirely) independent from their views about the medical system in general. This finding is also consistent with prior explanations that the nature of interpersonal physician trust evolves over the course of an ongoing treatment relationship to accommodate both more active and more passive patient roles.25 In fact, in our sample, trust in the specific physician was generally quite high regardless of preferred involvement in medical care.
Throughout all of these associations, the direction of possible causality is not established by this study. A person’s attitudes about involvement in medical care may be determined by their trust in the medical profession, or their trust may be determined by the types of involvement they have had in medical care. Most likely, there is a cyclical relationship between the 2.35
These findings provide reassurance that promoting trust will not likely cause a reversion to excessively paternalistic medical relationships. Trust in specific physicians is only weakly related to patients’ views about active vs passive roles. Trust in the medical profession is much more pertinent to these views, but that type of trust is distinct from trust in specific physicians. Moreover, trust in the medical profession is consistent with some desirable forms of patient involvement.
These findings also suggest that trust is able to form in relationships where patients are either active or passive. Assertive patient involvement should not be seen as indicative of distrust. Instead, other studies suggest that trust is promoted by communicating effectively with patients such as by listening carefully, answering questions clearly, giving them as much information as they want, and involving them in medical decisions.26,27
Attitudes towards involvement in medical care. Apart from the relationship to trust, these findings shed important light on general attitudes toward involvement in medical care. Overall, the majority of people report following their physicians’ recommendations and think that it is better to rely on the expert judgment of physicians and seek professional help. Most people think the physician and patient should share control equally and make decisions together. More patients give control to their physicians than to themselves. These findings are consistent with previous studies.8,28-36
