Trust in physicians and elements of the medical interaction in patients with rheumatoid arthritis and systemic lupus erythematosus

Trust between a patient and doctor is a key factor in promoting improved quality of life, compliance with treatment, and better health outcomes.

Without trust, the patient-doctor relationship may not become firmly established, thus potentially hindering physicians' ability to help patients. This is of special concern in the setting of rheumatic diseases, which are chronic and involve patient-doctor relationships that need to be established over a lifetime of disease; yet few studies have been conducted to identify the components of establishing trust in these patients. A new study published in the June 2006 issue of Arthritis Care & Research examined ethnically diverse patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) to determine the elements of the patient-doctor relationship associated with trust in physicians.

Led by Javier P. Berrios-Rivera of the Baylor College of Medicine in Houston, Texas, researchers assessed 102 patients with SLE or RA who were being treated at outpatient rheumatology clinics at publicly funded hospitals in Houston between September and November 2003. Patients responded to a questionnaire that assessed various aspects of the medical encounter, including doctors' informativeness, sensitivity to concerns, reassurance and support, and patient-centered behavior (e.g. "My doctors always ask me what I need"). Patients were also evaluated in terms of their willingness to disclose information to their physicians and their trust in the U.S. heath care system. Thirty-one percent of the patients were African-American, 43% were Latino and 25% were White.

The results showed that patients' trust of their doctors was independently associated with ethnicity, quality of the patient-doctor relationship, disease activity, and trust in the U.S. health care system. There was a lower level in trust observed in Latino and African-American patients, that the authors hypothesized could be due to subconscious biases or misconceptions on the part of physicians and/or patients that could interfere with open communication, empathy, and the development of trust. Physicians' patient-centered communication was the only variable that was significantly associated with patients' willingness to disclose information; the researchers did not find an association between trust or ethnicity and patient disclosure of information. "This finding suggests that physician interaction styles that are centered on patients' concerns result in more effective communication on the part of the patient, clearly reinforcing the importance of the doctor-patient dynamic," the authors state, adding that emphasizing these components of the patient-doctor relationship can lead to increased information sharing by patients.

Although the study may have been limited by its size, and by the fact that patients may have recalled only their most recent experiences (recall bias) or may have responded with answers they thought were socially acceptable, it has several strengths. It evaluated specific components of the patient-doctor encounter in an ethnically diverse group of patients, and it had nearly complete data for most of the questions. The authors suggest that additional studies in other patient populations are needed, but the current study indicates that improving doctor-patient communication would result in increased trust in physicians, which would positively affect health outcomes.

The authors conclude by stating that the, "data suggest that trust in physicians is significantly and independently associated with patient's ethnicity and specific components of physicians' communicative style, including informativeness, sensitivity to concerns, and patient-centeredness." Moreover, they add that trust can also be improved by being sensitive to patients' concerns and providing adequate medical information.