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

To ensure trustworthiness of the data, another team member (MB) reread the transcripts to identify and categorize statements related to trust that might have been missed by the software search and to confirm the assignments made by the first reviewer. The reviewers looked for patterns of similarities and differences in responses from the participants. Specifically, groups were compared by gender, age, and health condition for the dimensions of trust and the specific topics within each dimension that were discussed. Once the 2 reviewers agreed on the categorization of the comments, their interpretations were reviewed, discussed, and finalized by 2 other team members for further verification and to look for disconfirming data.

Results

All groups discussed topics related to at least 2 of the 5 dimensions of trust. Nine of the 12 groups discussed topics in at least 4 of the 5 dimensions.

Fidelity

Fidelity—the physician’s pursuit of the patient’s best interest, not taking advantage of the patient’s vulnerability—was discussed by 9 of the 12 groups. The words used by the adolescent participants to describe fidelity included caring, respect, and advocacy, as demonstrated below.

• 13-year-old male without chronic illness: “Doctors show they care by trying to understand how you’re feeling rather than just coming in to try to fix things.”
• 15-year-old male with Crohn’s disease: “If he asks for my opinion or if he takes my advice seriously…or how he talks to me. I know if he either respects me or not…if he doesn’t talk down to me, like, still doesn’t think I’m a little kid.”
• 13-year-old female with cystic fibrosis: “[A good doctor is] someone that you can trust to take care of you and do what’s right for you.”

When asked about behaviors that would diminish trust, several participants gave examples of how a physician might take advantage of an adolescent’s vulnerability. For example, a 15-year-old female without chronic illness mentioned she would lose trust if her doctor “touched her in the wrong way.” A 13-year-old male without chronic illness stated: “This never happened, but I just feel like it would happen like, as soon as my mom walks out of the door, the doctor would pull out that clipboard [and say] ‘Oh, I’m trying to ask these questions [about sensitive topics].’”

Confidentiality

Confidentiality (ie, keeping sensitive or private patient information from others) was discussed by nearly all of the groups. Although there was consensus about the overall importance of the dimension, adolescents varied in their beliefs about specific definitions, such as the types of information that should be kept confidential or from whom information should be withheld.

The general concept of confidentiality, however, was incorporated by many adolescents into descriptions of a good doctor and a trusted doctor. For example:

• 13-year-old male without chronic illness: “[A good doctor is] somebody who protects what you say and keeps things in a closed record to where nobody else can get to ’em.”
• 16-year-old female with cystic fibrosis: “He needs to keep that [conversation during doctor visit] zipped, especially when they talk to your parents afterwards. You may tell him something that you don’t want your parents to know about, and he should respect that if you tell him something.”

The following comment conveys how quickly an adolescent might lose trust in a doctor if confidentiality is broken:

• 19-year-old male with sickle-cell disease: “If I told my doctor something really personal that nobody else needed to know, and then he went and told everybody, I don’t care if it’s people on the hospital staff, sometimes I’ll be like ‘Uhhh, could you just keep this between us’ and if they go and tell everybody, that would make you lose trust in the doctor.”

Several younger males in one focus group expressed concern about information that might have been shared years earlier, when they were children:

• SUBJECT #1 (13-year-old male without chronic illness): “Because, some doctor, a doctor a long time ago when I was about 6, he sent my records all the way down to Children’s and it was not like what a normal doctor would do.”
• MODERATOR: “And that made you feel uncomfortable?”
• SUBJECT #1: “Yeah.”
• SUBJECT #2 (13-year-old male without chronic illness): “Like they were telling them everything.”
• SUBJECT #3 (11-year-old male without chronic illness): “And then next time you come: ‘Oh there’s the sick boy’.”
• SUBJECT #4 (13-year-old male without chronic illness): “Yeah.”

Competency

Six of the 12 groups, particularly the older female groups, discussed competency in terms of trusting their doctors and identifying what makes a good doctor. As with other dimensions, the discussions explored both the presence and absence of competency: