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Patient Trust: Is It Related to Patient-Centered Behavior of Primary Care Physicians?

Fiscella, Kevin MD, MPH*†; Meldrum, Sean MS*; Franks, Peter MD; Shields, Cleveland G. PhD; Duberstein, Paul PhD§; McDaniel, Susan H. PhD; Epstein, Ronald M. MD

Original Article

Background: Patients’ trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients.

Methods: We assessed physician behavior and length of visit using audio tapes of encounters of 2 unannounced standardized patients (SPs) with 100 community-based primary care physicians participating in a large managed care organization. Physician behavior was assessed via 3 components of the Measure of Patient-Centered Communication (MPCC) scale. The Primary Care Assessment Survey (PCAS) trust subscale was administered to 50 patients from each physician's practice and to SPs. We used multilevel modeling to examine the associations between physicians’ Patient-Centered Communication during the SP visits and ratings of trust by both patients and SPs.

Results: Component 1 of the MPCC, which explored the patient's experience of the disease and illness, was independently associated with patient's rating of trust in their physician. A 1 SD increase in this score was associated with 0.08 SD increase in trust (95% confidence interval 0.02–0.14). Each additional minute spent in SP visits was also independently associated with 0.01 SD increase in patient trust. (95% confidence interval 0.0001–0.02). Component 1 and visit length were also positively associated with SP trust ratings.

Conclusions: Physician verbal behavior during an SP encounter is associated with trust reported by SPs and patients. Research is needed to determine whether interventions designed to enhance physicians’ exploration patients’ experiences of disease and illness improves trust.

From the *Departments of Family Medicine, †Community & Preventive Medicine, and §Psychiatry; and the ¶Rochester Center to Improve Communication in Health Care, University of Rochester School of Medicine & Dentistry, Rochester, New York; and the ‡Center for Health Services Research in Primary Care, Department of Family & Community Medicine, University of California at Davis, Sacramento, California.

This project was supported by Grant number R01HS10610 from the Agency for Healthcare Research and Quality.

Reprints: Kevin Fiscella, MD, MPH, 1381 South Avenue, Rochester, NY 14620-2830. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.