Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study

Abstract

BackgroundNew patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Persons with HIV infection may be an ideal population to study the drivers of a positive initial patient-provider relationship, as it is a chronic and serious condition that requires a reliable, ongoing relationship with a provider. Informed by patients’ real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset.MethodsWe conducted longitudinal, in-person interviews with 21 patients new to the HIV clinic at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, from August 2013 to March 2015. Patients were interviewed across three time points: once before their first provider visit, a second time within two weeks after the first visit, and a third time at 6 to 12 months after the first provider visit.ResultsWe conducted 61 h of patient interviews. The mean age was 53 years; 52% were non-Hispanic white, 23% were non-Hispanic black and 19% were Hispanic. Patients described significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider. Our analysis of these experiences revealed five actions providers can take to reduce their patients’ anxiety and build trust early in the first visit: 1) provide reassurance to patients, 2) tell patients it’s okay to ask questions, 3) show patients their lab results and explain what they mean, 4) avoid language and behaviors that are judgmental of patients, and 5) ask patients what they want [i.e., treatment goals and preferences].ConclusionsOur study incorporates direct input from patients and highlights the unique psychological challenges that patients face in seeking care from a new provider. The actionable opportunities cited by patients have the potential to mitigate patients’ feelings of anxiety and vulnerability, and thereby improve their overall health care experience.

It is Time to Include Telehealth in Our Measure of Patient Retention in HIV Care

“…However, when rolled out to the general population of patients with HIV infection, will certain subpopulations benefit more or less? Our team has published data showing the importance of effective communication and patient experience in predicting retention in HIV care [9][10][11]. In using telehealth, we must consider how telehealth alters communication and patient experience, and how differences in communication and patient experience may impact long term adherence and retention.…”

“…Previous studies have found that patients tend to feel rushed during telehealth visits [12], even though telehealth visits tend to be longer; providers use less encouraging language during telehealth visits [13]; and these visits tend to be provider-dominated [14]. If telehealth use continues post-pandemic, providers may need communication skills training specific to telehealth (e.g., acknowledging/validating emotions without the ability to use common non-verbal cues) [9,10].…”

Health Literacy, Health Numeracy, and Trust in Doctor: Effects on Key Patient Health Outcomes

“…Two qualitative studies and evidence from the services literature add credence to this possibility. Roth (1994) and Dang et al (2017) found that trust in doctor established early in the patient-doctor relationship was associated with more frequent visits, and at the highest level this relationship may even be more pronounced than at more moderate or high levels (i.e., a curvilinear pattern). Likewise, in a non-health care service context, Agustin and Singh (2005) showed that trust in provider had a positive quadratic effect on loyalty (a behavioral outcome).…”

Socio‐economic differences in patient participation behaviours in doctor–patient interactions—A systematic mapping review of the literature

“…The most commonly used measure to explore relationships between patient participation behaviours and SES was educational level (45 studies). Only four studies used occupation as an indicator of SES, [20][21][22][23] and only two studies used a composite measure of deprivation. 24,25 One study measured housing situation and receipt of benefits, 26 one used a composite measure of social class, 27 and one looked at financial strain and finances at the end of the month.…”