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Patients’ trust in their physicians

Effects of choice, continuity, and payment method

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Abstract

OBJECTIVE: To evaluate the extent to which physician choice, length of patient-physician relationship, and perceived physician payment method predict patients’ trust in their physician.

DESIGN: Survey of patients of physicians in Atlanta, Georgia.

PATIENTS: Subjects were 292 patients aged 18 years and older.

MEASUREMENTS AND MAIN RESULTS: Scale of patients’ trust in their physician was the main outcome measure. Most patients completely trusted their physicians “to put their needs above all other considerations” (69%). Patients who reported having enough choice of physician (p<.05), a longer relationship with the physician (p<.001), and who trusted their managed care organization (p<.001) were more likely to trust their physician. Approximately two thirds of all respondents did not know the method by which their physician was paid. The majority of patients believed paying a physician each time a test is done rather than a fixed monthly amount would not affect their care (72.4%). However, 40.5% of all respondents believed paying a physician more for ordering fewer than the average number of tests would make their care worse. Of these patients, 53.3% would accept higher copayments to obtain necessary medical tests.

CONCLUSIONS: Patients’ trust in their physician is related to having a choice of physicians, having a longer relationship with their physician, and trusting their managed care organization. Most patients are unaware of their physician’s payment method, but many are concerned about payment methods that might discourage medical use.

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References

  1. Beauchamp T, Childless J. Principles of Biomedical Ethics. 3rd ed. New York, NY: Oxford University Press; 1989.

    Google Scholar 

  2. Katz J. The Silent World of Doctor and Patient. New York, NY: Free Press; 1984.

    Google Scholar 

  3. Macklin R. Enemies of Patients. New York, NY: Oxford University Press; 1993.

    Google Scholar 

  4. Rodwin M. Medicine, Money and Morals. New York, NY: Oxford University Press; 1993.

    Google Scholar 

  5. Emanuel EJ, Dubler NN. Preserving the physician-patient relationship in the era of managed care. JAMA. 1995;273:323–9.

    Article  PubMed  CAS  Google Scholar 

  6. Barber B. The Logic and Limits of Trust. New Brunswick, NJ: Rutgers University Press; 1983.

    Google Scholar 

  7. Gambetta D, ed. Trust: Making and Breaking Cooperative Relations. New York, NY: Blackwell; 1988.

    Google Scholar 

  8. Kramer RM, Tyler TR, eds. Trust in Organizations: Frontiers of Theory and Research. Thousand Oaks, Calif: Sage; 1996.

    Google Scholar 

  9. Mechanic D. Changing medical organization and the erosion of trust. Milbank Q. 1996;74:171–89.

    Article  PubMed  CAS  Google Scholar 

  10. Blendon RJ, Knox RA, Brodie M, Benson JM, Chervinsky G. Americans compare managed care, Medicare, and fee-for-service. J Am Health Policy. 1994;4:42–7.

    PubMed  CAS  Google Scholar 

  11. Hoerger TJ, Howard LZ. Search behavior and choice of physician in the market for prental care. Med Care. 1995;33:332–49.

    Article  PubMed  CAS  Google Scholar 

  12. Mechanic D, Ettel T, Davis D. Choosing among health insurance options: a study of new employees. Inquiry. 1990;27:14–23.

    Google Scholar 

  13. Mitchell JH, Dunn JP. Employee’s choice of a health plan and their subsequent satisfaction. J Occup Med. 1984;26:361–6.

    Article  PubMed  CAS  Google Scholar 

  14. Hillman AL, Pauly MV, Kerstein JJ. How do payment methods affect physicians’ clinical decisions and the financial performance of health maintenance organizations? N Engl J Med. 1989;321:86–92.

    Article  PubMed  CAS  Google Scholar 

  15. Hillman AL. The impact of physician payment methods on high-risk populations in managed care. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8(Suppl 1):S23–30.

    PubMed  Google Scholar 

  16. Sulmasy DP. Physicians, cost control, and ethics. Ann Intern Med. 1992;116:920–6.

    PubMed  CAS  Google Scholar 

  17. Anderson LA, Dedrick RF. Development of the trust in physician scale: a measure to assess trust in patient-physician relationships. Psychol Rep. 1990;67:1091–100.

    Article  Google Scholar 

  18. Kanter DL, Mirvis PH. The Cynical Americans: Living and Working in an Age of Discontent and Disillusion. San Francisco, Calif: Jossey-Bass; 1989.

    Google Scholar 

  19. Janoff-Bulman R. Assumptive worlds and the stress of traumatic events: applications of the schema construct. Soc Cognition. 1993;7:113–36.

    Google Scholar 

  20. Coleman PG, Shellow RA. Privacy and autonomy in the physician-patient relationship: independent contracting under Medicare and implications for expansion into managed care. J Leg Med. 1995;16:509–43.

    PubMed  CAS  Google Scholar 

  21. Wennberg JE. Health care reform and professionalism. Inquiry. 1994;31:296–302.

    PubMed  CAS  Google Scholar 

  22. Sederer LI, Mirin SM. The impact of managed care on clinical practice. Psychiatr Q. 1994;65:177–88.

    Article  PubMed  CAS  Google Scholar 

  23. Dubler NN. Individual advocacy as a governing principle. J Case Manage. 1992;1:82–6.

    CAS  Google Scholar 

  24. Rosenthal TC, Teimenschneider TA, Feather J. Preserving the patient referral process in the managed care environment. Am J Med. 1996;100:338–43.

    Article  PubMed  CAS  Google Scholar 

  25. Korcok M. Capitation begins to transform the face of American medicine. Can Med Assoc J. 1996;154:688–91.

    CAS  Google Scholar 

  26. Flynn MB. Power, professionalism, and patient advocacy. Am J Surg. 1995;170:407–9.

    Article  PubMed  CAS  Google Scholar 

  27. Apple GJ. Who bears the risk when physicians are also insurers? Minn Med. 1995;78:23–7.

    PubMed  CAS  Google Scholar 

  28. Clouthier M. The evolution of managed care. Trends Health Care Law Ethics. 1995;10:67–72.

    Google Scholar 

  29. Solberg LI, Isham G, Kottke TE, et al. Competing HMOs collaborate to improve preventive services. Jt J Qual Improv. 1995;21:600–10.

    CAS  Google Scholar 

  30. Morrow RW, Gooding AD, Clark C. Improving physicians’ preventive health care behavior through peer review and payment methods. Arch Fam Med. 1995;4:165–9.

    Article  PubMed  CAS  Google Scholar 

  31. Robinson JA, Robinson KJ, Lewis DJ. Balancing quality of care and cost-effectiveness through case management. Anna J. 1992;19:182–8.

    PubMed  CAS  Google Scholar 

  32. Angell M. The doctor as double agent. Kennedy Inst J Ethics. 1993;3:279–86.

    CAS  Google Scholar 

  33. Orentlicher D. Managed care and the threat to the patient-physician relationship. Trends Health Care Law Ethics. 1995;101:19–24.

    Google Scholar 

  34. Swee DE. Health care system reform and the changing physician-patient relationship. N J Med. 1995;92:313–7.

    PubMed  CAS  Google Scholar 

  35. Rodwin MA. Conflicts in managed care. N Engl J Med. 1995;332:604–7.

    Article  PubMed  CAS  Google Scholar 

  36. Nelms CR Jr. Ethical physicians cannot serve two masters. Minn Med. 1994;77:51.

    Google Scholar 

  37. Lipset SM, Schneider W. The Confidence Gap: Business, Labor, and Government in the Public Mind. New York, NY: Free Press; 1983.

    Google Scholar 

  38. Sheppard BH, Lewicki RJ, Minton JW. Organization Justice: The Search for Fairness in the Workplace. Lexington, Mass: Lexington Books; 1992.

    Google Scholar 

  39. Gray BH. Trust and trustworthy care in the managed care era. Health Affairs. 1997;16:34–49.

    Article  PubMed  CAS  Google Scholar 

  40. Duck S, Perlman D, eds. Understanding Personal Relationships. Beverly Hills, Calif: Sage; 1985.

    Google Scholar 

  41. National Survey of Employer-Sponsored Health Plans. New York, NY: Foster Higgins; 1996.

  42. Group Health Association of America/American Medical Care and Review Association Managed Health Care Directory. Washington, DC: AMCRA; 1995.

  43. Mechanic D, Schlesinger M. The impact of managed care on patients’ trust in medical care and their physicians. JAMA. 1996;275:1693–7.

    Article  PubMed  CAS  Google Scholar 

  44. Montague J. Managed care is dumping many physicians, but some aren’t going to take it lying down. Striking back. Hosp Health Netw. 1994;68:38–44.

    CAS  Google Scholar 

  45. Bailey CW Jr. How to avoid being dropped from managed care plans. Postgrad Med. 1994;95:59–62.

    PubMed  Google Scholar 

  46. Guglielmo WJ. How to avoid deselection. Med Econ. 1996;73:149–54.

    PubMed  CAS  Google Scholar 

  47. Graddy B. TMA takes aim against deselection. Tex Med. 1994;90:14–47.

    PubMed  CAS  Google Scholar 

  48. Ortolon K. Deselection, round two: TMA takes due process with managed care organizations to US Congress. Tex Med. 1994;90:20–2.

    Google Scholar 

  49. Brouillette JN. Bilateral deselection. J Fla Med Assoc. 1995;82:423.

    PubMed  CAS  Google Scholar 

  50. Morreim EH. Economic disclosure and economic advocacy. New duties in the medical standard of care. J Leg Med. 1991;12:275–329.

    Article  PubMed  CAS  Google Scholar 

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This work was funded by the Prudential Center for Health Care Research. During the conduct of this study, Dr. Cleary was a consultant to the Prudential Center for Health Care Research. The authors thank Barbara McNeil, MD, PhD, and Carol McPhillips-Tangum, MPH, for their helpful comments on the study, Sean Lee for data programming, and Linda Emanuel, MD, PhD, for her review of the manuscript.

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Kao, A.C., Green, D.C., Davis, N.A. et al. Patients’ trust in their physicians. J GEN INTERN MED 13, 681–686 (1998). https://doi.org/10.1046/j.1525-1497.1998.00204.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1998.00204.x

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