Building a trusting physician-patient relationship is multifactorial and unlikely to develop during 1 or 2 visits. Health systems that allow only the most seriously ill patients to see their physicians inhibit the development of a trusting relationship. Creating a professional working environment that fosters trust is challenging; however, the rewards for delivering quality care in a cost-effective manner that is satisfying to both patients and physicians make these efforts worthwhile.
Training Strategies for Building Trust
There are many strategies that should support the relationship at different levels within the health care system. When assessing applicants for medical school, use of Thom’s findings should guide admission committees when they are assessing an applicant’s capacity to build trusting relationships. Many medical schools have developed a problem-based curriculum that emphasizes self-directed learning, effective communications skills, and teamwork. With the bedside replacing the lecture hall as the site of learning, students should be taught the skills necessary to promote competence and effective communication. Postgraduate education in family practice and other primary care disciplines emphasizes clinical competence and communication skills. This education should enhance the ability of physicians to build trusting relationships.
Physicians in the United States and Canada must regularly undergo reexamination, both of their knowledge and the quality of their record-keeping. In addition, quality assurance and programs to maintain licensure are emphasizing the importance of clinical competence and communication skills. Increased transparency of the disciplinary review processes has also served to buffer public concerns about cases of physician breach of trust. However, patients are still concerned that the family physician they know and trust will not be available when their need is greatest. A reduction in the number of physicians offering comprehensive care has seriously eroded the public’s confidence in health care systems. A team approach that emphasizes comprehensive services continuity of care can address these concerns but must be implemented carefully to avoid interference with the physician-patient relationship. Collaborative and shared care models need to be developed as the focus of care between primary care physicians, team members, and specialist colleagues.
The complexity involved in the building of a trusting physician-patient relationship requires sensitivity at every level of the health care system. More research is needed into the methods of developing and enhancing trusting relationships, so future physicians will be better prepared for the scrutiny of their patients.9 Practicing physicians should receive further education on ways to maintain and improve trust in the relationship with their patients. Policies to minimize third-party intrusion on the physician-patient relationship should be strengthened. Continuing vigilance to threats in the health care system that lessen patient trust will ensure that the desirable physician characteristics described by Hippocrates continue to be met and enhanced.