Changing Medical Organization and the Erosion of Trust

Mechanic, David

doi:10.2307/3350245

Cited by 410 publications

(341 citation statements)

References 32 publications

Supporting

Mentioning

331

Contrasting

Unclassified

Order By: Relevance

“…Trust inheres in both individual care providers and health care systems. 18,19 As well as truth telling, dimensions of trust include, fidelity, honesty, and competence. 20 Fidelity and honesty involve disclosing conflicts of interest, a theme emergent from participants' descriptions of wider health care encounters.…”

Section: System-based Issuesmentioning

confidence: 99%

“…It is associated with treatment adherence, practitioner loyalty, not seeking second opinions, recommendations to others, and perceived effectiveness of care. [18][19][20] Participants' comments reflected the 'competence dimension' of trust. Ophthalmologists in the HES have been shown to be more optimistic about patients' levels of knowledge and understanding following a consultation than is actually reported by patients themselves.…”

Section: Provider-based Issuesmentioning

confidence: 99%

See 1 more Smart Citation

ReGAE 2: glaucoma awareness and the primary eye-care service: some perceptions among African Caribbeans in Birmingham UK

Cross

Shah

Bativala

et al. 2006

Eye

View full text Add to dashboard Cite

Aims Investigations into glaucoma awareness have drawn on informed, clinicbased populations. The paper reports a section of findings from a larger study that aimed to elicit the perceptions of those potentially less informed in community settings. Methods A qualitative investigation used face-to-face interviews and focus group discussions with 48 African Caribbean participants outside the hospital eye-service. Interview data were transcribed and coded using manual and computer-aided methods. Inferences and interpretations were corroborated by discussion with expert advisors and community members not directly involved in the study. Results Positive attitudes to health promotion existed, but 'eye health' did not appear to be integral to individuals' health schemas. The capacity for primary eye care to enhance glaucoma knowledge appeared under utilised and inconsistent across modes of service delivery and was undermined by perceived conflicts of interest. Conclusions Enhancing reciprocal understanding between service users and ophthalmic practitioners in primary care is central to developing flexible, responsive local eye-care services. The study suggested useful foci for cultural self-reflection and selfawareness on the part of health professionals themselves, in relation to glaucoma detection. Areas for further research are identified.

show abstract

Section: System-based Issuesmentioning

confidence: 99%

Section: Provider-based Issuesmentioning

confidence: 99%

ReGAE 2: glaucoma awareness and the primary eye-care service: some perceptions among African Caribbeans in Birmingham UK

Cross

Shah

Bativala

et al. 2006

Eye

View full text Add to dashboard Cite

show abstract

“…9 Having a choice of physician is important to many patients, [10][11][12][13] and it is possible that wider choices would encourage greater trust in the physician eventually chosen. Recent developments in health care delivery also make it plausible that the way physicians are paid could influence patients' trust in them.…”

mentioning

confidence: 99%

Patients’ trust in their physicians

et al. 1998

View full text Add to dashboard Cite

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 Ͻ .05), a longer relationship with the physician ( p Ͻ .001), and who trusted their managed care organization ( p Ͻ .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. T rust is a fundamental aspect of the patient-physician relationship. 1-5 Even well-informed and knowledgeable patients have to rely on their physicians to provide them with appropriate information, keep personal information confidential, provide competent care, and act in their best interests. In spite of the importance of trust to the patient-physician relationship, there are few studies of the factors related to patients' trust in their physicians. CONCLUSIONS:One predictor of trust in social relationships is the length of those relationships, 6-8 and there is reason to believe this would hold for patient-physician relationships. 9 Having a choice of physician is important to many patients, 10-13 and it is possible that wider choices would encourage greater trust in the physician eventually chosen. Recent developments in health care delivery also make it plausible that the way physicians are paid could influence patients' trust in them. Reports regularly appear in the popular press about how new managed care arrangements may compromise the care provided to patients. Health service researchers have shown that payment methods may have an impact on clinical decision making. 14-16 We know of no empirical studies that have examined whether patients' beliefs about how their physician is paid affect their trust in the physician. In the study described herein, we interviewed a probability sample of patients covered by a large health care insurer in Atlanta. We assessed how patients thought their physicians were paid and whether their perceptions were accurate. We also examined whether availability of a choice of physicians, length of patient-physician relationship, or perceived physician payment method was related to the patients' trust in their physician. METHODS Study Design and SampleThe study was con...

show abstract

“…Trust between patient and physician has an important value for therapy and results of treatment [12]. It helps to improve communication, cooperation in treatment, ability to cope with uncertainties [15]. As it showed by studies, patients demonstrate more beneficial health behaviors, less symptoms and higher quality of life when they had higher trust in their health care professional [1].…”

Section: Problem Statementmentioning

confidence: 99%

“…These reforms are motivated by the social-economic environment changes of medicine as a social institute. As it showed by the numerous studies, under the globalization and new technologies the clinical practice has been changed [15]. The high technologies in medicine have incorporated new trends in practice and lead to use exactly hard evidence for diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%