A new study (2/2002) shows that good communication is the most important consideration for building patients' trust in their physician.

"Patients value health information highly, particularly health education and discussion of treatments," say the study's lead author Nancy L. Keating, M.D., M.P.H., of Harvard Medical School. "However, evidence suggests that physicians underestimate patients' desire for health information and overestimate the amount of time they spend providing it."

In the study published in the January issue of the Journal of General Internal Medicine, more than 2,000 patients were surveyed about their doctor visits and whether they had considered switching primary care providers. Survey questions covered how well doctors informed respondents of medical options, offered understandable explanations, took enough time to answer questions or give information and involved them in medical decisions.

Predictably, the more problems patients reported with their doctor, the more likely patients were to consider changing doctors. Overall, 12 percent of patients said they had considered changing doctors, the authors found.

However, controlling for other variables, patients were more likely to consider changing physicians because of poor communication. Patients also considered making a change if their doctor didn't order tests, procedures or referrals the patient thought necessary.

"Providers' decisions to limit tests, procedures or referrals are often entirely appropriate. Communication strategies to increase discussion about such decisions may result in fewer patients leaving the office feeling that they were not provided a needed service," they suggest.

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They also found that patients who felt left out of decisions were less trusting of their doctors, but they were no more likely to consider changing doctors, when adjusting for other problem experiences, says Keating.

"Although most patients' experiences with their physicians are good, those that are not may have important consequences, including lower trust, lower ratings of physicians and greater likelihood of changing physicians," the author say, pointing out that changing doctors can affect quality by interrupting continuity of care.

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The study was funded in part by the Prudential Center for Health Care Research, which has now become the USQA Center for Health Care Research. The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care.


Center for the Advancement of Health