RELATION OF TRUST IN THE

DOCTOR
AUGUST 2023
 Plan
• Clarify the concept of trust in the therapeutic
relationship
• The “virtues” of trust.
• The transformations of the doctor-patient
relationship and the characteristics of trust
nowadays.
 What is trust?
▪ It makes collective life possible (“lubricant” of
social relations; “accelerator of cooperation”)
▪ A society cannot function optimally:
o if individuals do not trust each other
o if individuals do not trust their environment.
▪ Trust= sociocultural entity, a belief which is not
purely psychological.
▪ It occurs in a complex social and institutional
context (personal past experiences,
representations, values, knowledge, etc….)
Definition of Trust
• The Oxford English dictionary defines trust as firm belief
based on experience, qualities such as honesty and veracity, and
actions such as justice and strength of a person or thing.
Background
• The changing pattern in the doctor-patient relationship is becoming
more of a challenge for health care providers.
• For a healthy and effective doctor-patient relation, trust and
communication is considered to play a vital role.
History
• Two-thousand three hundred years ago the Hippocratic oath
originally outlined appropriate trust-building behavior for
physicians.
• The sustained use of the oath reflects how profoundly important
physician behavior is for establishing trust in relationships with
patients
Introduction
• Over the years, changing patterns in the society, advances in the
medical care and easy access to medical information has made
the doctor-patient relationship challenging.
• Previously, the doctors were considered as the receptacle of all
medical knowledge and this was used for patient management.
• In today’s era, things are a bit different.
• The medical knowledge has become a commodity between the
doctor and the patient and treatment is customized to individual
patients.
• The famous Canadian physician, Sir William Osler known for
teaching at bedside, stated, “A good physician treats the disease
and a great physician treats the patient who has the disease” .

❖ Assumption of competence and benevolence (kindness)

• To provide the patient with high quality care, there needs
to be a healthy doctor- patient relationship.
▪ Communication and trust are the key elements among the other
factors in building a healthy relationship .
▪ Effective communication has always been one of the ingredients of
success in all fields of work.
• In health care settings, trust and communication are labeled a
tool for better patient care and patient satisfaction.
❖There is a necessity to have some degree of trust to build a climate in
which honest communication can flourish.
❖Effective and efficient communication is a predictor of medical practice
and delivery of health care services
❖The quality of interaction with the patients is positively related to trust and
patient satisfaction.
❖All of these are either direct or indirect measures of the quality of health
care services.
Trust in doctor-patient relationship
• Trust is one of the essential components and fundamental part
of doctor-patient relationship.
➢In general, to trust means to believe that someone is honest, nice or good,
and will not harm you.
➢ In the medical field for some patients, it can be their belief or expectation
for the physician to behave in a certain way.
➢Patients might expect their health care provider to be competent,
compassionate, honest, empathic, dependable and interested in their good
will and expect a good outcome of their visit.
➢Trust in a doctor-patient relationship is something that involves
both confidence and reliance.
• The patients are put in a vulnerable situation where they believe that
the care-providers will care for their interest.
• For their own good, patients need to trust the doctors with their
private information and body which is essential for their proper
management.
• Trust in the medical field can be considered as either institutional
trust or interpersonal trust.
• For healthcare system, interpersonal trust is built, sustained or
damaged through face to face encounters with health care providers.
▪ As for the institutional trust it is placed on the medical system or the
institution.
▪ The doctor-patient interaction is influenced by both personality and
social systems and trust occurs in a framework of interaction which is
influenced by both personality and social systems.
Determinants of trust
• Trust is a complex and complicated subject that has been looked at
with different perspective.
• Depending on sociocultural context, different factor can give rise
to trust as well.
• For a developing country, factors which influence patient’s trust in
doctors includes the doctor's behavior, perceived comfort levels,
personal involvement with the patient, and to a lesser extent by
cultural competence and doctor's physical appearance.
• Fruitful trust is something that cannot just happen, rather it must
be developed and maintained.
• Communication is one of the dimensions of physician behavior on
which patients base their trust.
Doctor-patient communication
• Improving the communication skills helps the doctors to build an
effective relationship between doctors and patients.
• Hence, from a clinical perspective, effective and efficient
communication is a tool that helps doctors in providing quality care to
their patients.
• Physicians with good communication and interpersonal skills tend to
gather a proper history from the patient, which guides the
appropriate examinations and then management.
• It facilitates exchange of information and includes patients in decision
making.
• Currently, there is a greater expectation of collaborative decision
making.
• Physicians and patients participate as partners to achieve the agreed
upon goals and the attainment of quality of life.
Trust, communication and patient
satisfaction
• Studies have shown that patient satisfaction is positively correlated
with communication skills.
• When it comes to patients with chronic disease, trust and
communication carry the same value in their satisfaction with the
care provided.
• There is a need for doctors to develop good interpersonal and
communicating skills in-order to have an effective and quality doctor-
patient interaction with their diabetic patients.
• A physician’s competency is reflected in the patient satisfaction of
their interaction with the doctor.
Trust, communication and healthcare
quality
• Trust has been shown to have a positive impact on patients such as
patient’s adherence to medication, patient satisfaction, and better
indicator of follow up treatment
• Patients with higher trust in their physician usually have more beneficial
health behaviours, less symptoms, higher quality of like and were more
satisfied with the treatment.
• Healthcare providers, especially doctors, must convince their patients to
share personal information, submit to tests and take chemicals in the form
of medication in their body.
• Trust plays a vital role to get all this done.
• Patient satisfaction, which is influenced by trust is an important
indicator to know the quality of the hospital and clinical services
provided.
• Studies have shown a strong correlation between patient satisfaction
and quality, including safety of health care.
• A review showed that improved patient satisfaction was associated
with increased levels of adherence to treatment processes and
recommended prevention, improved clinical outcomes, better patient
safety within hospitals and less health care utilization.
• As mentioned trust is complex concept both from the doctors and
patient’s perspectives.
• Even though, trust in a doctor-patient relationship has advantages
such as avoiding unnecessary outrage due to inferior performance.
• Overall, it is important to for individual health care facilities to carry
out their patient satisfaction surveys to facilitate strategy formulation
of effective and efficient quality of health care services and better
patient outcomes.
CONCLUSION- PART 1
• The current literature illustrates the importance of trust and
communication in a doctor-patient relationship for a better and
effective treatment given to the patients.
• Trust is something that must be built and gained and having good
communication skills, assists in building this trust between a doctor
and patient.
• The evidence shows that trust and communication with a patient -
centered approach has contributed to improved patient outcomes
with patients being satisfied with the services they were offered at
the health facility.
• This is associated with better adherence to the treatment and better
perceived quality of health care services.
• The importance of trust and communication in a doctor -patient
relationship carry the same importance for both developed and
developing countries in terms of patient satisfaction and quality of
health care services, though the determinants may differ slightly.
Continued…
 Advantages for the Advantages for the
patient doctor

• Communication • Facilitates history taking

• Lessens anxiety • Improves diagnostic quality
and treatment
• Overcomes uncertainty
• Improves cooperation and
• Reduces the feeling of
adherence to treatment
vulnerability
• Continuity of care
• Limits risks of litigation
 Traditional trust

• Prestige and aura of the doctor

• Strong asymmetry (ignorant patient/expert doctor)
• Delegation, compliance, medical decision
(paternalism)
• “Submission” to authority
Social transformations of the doctor-patient relationship

• Popularisation of medical knowledge

• Medicalisation of society
• Familiarisation with the medical environment
• Increasing health aspirations
• Lesser prestige of the profession
• Assertion of the patient towards medicine
• Patient-consumer image
• Pluralism of therapy
• “Consumerism” of health and medicine
• Judicial aspects of health care (litigations for malpractice)
• Medical errors in media
• Scandals
 The democratic model
• Dialogue, openness, communication
• Sharing of information
• Participation to decisions
• Taking into account psychology of the patient
• Transparency, truth
 Trust nowadays
• Not anymore based only on:
✓ Knowledge, expertise
✓ Professional status, titles
✓ Symbolic attributes

• Basic definition of a “good” doctor:

✓ Competencies, experience, rigour
✓ Capacity to listen, quality of contact, respect

• Not automatic anymore → is constructed through the

relation with the patient.
• Not guaranteed but conditional → can be reinforced, eroded
or broken.
• Not homogeneous → can take many forms (autonomy,
information…) and varies in intensity (blind trust v/s critical
vigilance),
 I trust because:
• S/he is the doctor, s/he knows
• I like him/her very much, s/he is nice
• S/he always found what was wrong and treated
me quickly
• S/he listens to me, I can tell him/her everything,
I can confide without being judged.
• S/he does not impose anything, s/he informs me
and we decide together, I can say no.
• S/he knows his/her limitations and does not
waste time before sending me to a specialist.
 The patient’s trust
is modulated by several factors
• Severity of the disease, of symptoms
• Technical competencies of the doctor
• Doctor’s attitude, the quality of the contact
(listening, respect, communication, information, …)
• Personality of the patient
• Prior experiences
• Age, social and cultural background
• Expectations, attitudes and representations (health,
disease, body, role of the doctor…)
• …
THANK YOU