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

When asked how doctors could gain the trust of adolescent patients, participants in our study responded “be truthful,” “be friendly,” and “be there.” More specific behaviors included asking for the adolescent’s opinion, keeping private information confidential, not withholding clinical information from the patient, and engaging in small talk to show concern.

Participants were quick to point out that physician violation of gained trust is viewed as serious behavior that leads to rapid deterioration in the doctor-patient relationship.^3,19 They identified examples of violated trust as medical mistakes, breaks in confidentiality, and taking advantage of patients when vulnerable (eg, during the physical examination). These descriptions highlight the importance of proactive discussions early in the doctor-patient relationship, clarifying the legal and ethical limitations of issues such as confidentiality.

There are several limitations to this study. First, these analyses were part of a larger study examining health care preferences of adolescents with a chronic illness. Because the issue of physician-patient trust was not the focal point of the original study, there may be issues relating to trust that our study did not address. Further research with additional samples is needed to confirm if all aspects of trust were explored.

Second, while our findings support those of earlier studies in both adolescents and adults, our sample was drawn from the patient population of only one mid-western city in the US.^7-9,20

Third, adolescents who declined participation in the study may differ in their attitudes or beliefs about health care providers than adolescents who agreed to participate, thus introducing a potential selection bias.

Fourth, we were unable to perform member checking or reactor panels to examine “external validity” due to the participants’ cognitive level (ie, difficulty discussing abstract concepts). However, corroborating evidence from earlier studies supported our findings.

Fifth, our study was designed to collect qualitative data and to use analytic methods that are appropriate for such data. The data and statistical methods were not intended to be quantitative, and the interpretations of the reported findings therefore were appropriate for those of a qualitative, not quantitative study design.

In conclusion, our study provides the first steps in suggesting that adolescents and adults agree on the major dimensions of trust but differ in the relative importance of these dimensions to the overall definition of trust. Adolescents in our study expressed the broadest range of beliefs within the dimension of confidentiality. Younger adolescents expressed more concern and uncertainty about how health information is protected than did older adolescents.

Adolescents with chronic illnesses seemed more comfortable involving parents in their care than did adolescents without chronic illnesses. Since adolescents with chronic illness have more experience involving their parents in their care, future studies could examine whether having a chronic illness makes a difference in whether an adolescent would involve their parent more when faced with the same health concerns typical of healthy adolescents (eg, sexual health, psychological issues).

Additional studies focusing specifically on physician-patient trust are needed to further explore similarities and differences between adults and adolescents’ perceptions. Understanding the importance of trust to adolescents and listening to their recommendations about behaviors that promote it may help physicians build positive relationships with patients that will continue into and beyond young adulthood.

Acknowledgments

Supported by a Robert Wood Johnson Generalist Physician Faculty Scholar Award to the senior author.

CORRESPONDING AUTHOR
Brenda K. Klostermann, PhD, Illinois Education Research Council, Southern Illinois University Edwardsville, Box 1064, Edwardsville, IL 62026-1064. E-mail: breklos@siue.edu