How are patients' specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians?

Abstract

Context: Few data are available regarding the consequences of patients' problems with interpersonal aspects of medical care.

Objective: To assess the relationships between outpatient problem experiences and patients' trust in their physicians, ratings of their physicians, and consideration of changing physicians. We classified as problem experiences patients' reports that their physician does not always 1) give them enough time to explain the reason for the visit, 2) give answers to questions that are understandable, 3) take enough time to answer questions, 4) ask about how their family or living situation affects their health, 5) give as much medical information as they want, or 6) involve them in decisions as much as they want.

Design: Telephone survey during 1997.

Participants: Patients (N=2,052; 58% response) insured by a large national health insurer.

Measurements: Patient trust, overall ratings of physicians, and having considered changing physicians.

Results: Most patients (78%) reported at least 1 problem experience. In multivariable analyses, each problem experience was independently associated with lower trust (all P <.001) and 5 of 6 with lower overall ratings (P <.001). Three problem experiences were independently related to considering changing physicians: physicians not always giving answers to questions that are understandable (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3 to 3.0), not always taking enough time to answer questions (OR, 3.3; 95% CI, 2.2 to 5.2), and not always giving enough medical information (OR, 4.0; 95% CI, 2.4 to 6.6).

Conclusions: Problem experiences in the ambulatory setting are strongly related to lower trust. Several are also associated with lower overall ratings and with considering changing physicians, particularly problems related to communication of health information. Efforts to improve patients' experiences may promote more trusting relationships and greater continuity and therefore should be a priority for physicians, educators, and health care organizations.

FIGURE 1

Proposed framework for examining the relationship between patients' experiences in the office and trust, ratings of physicians, and considerations of changing physicians. This model depicts plausible pathways for these relationships, recognizing that other factors such as patient and physician characteristics and beliefs may influence each step of the pathway and that some of the pathways may have reciprocal effects.

FIGURE 2

Percentage of patients who have considered changing their physician by number of problems. Number of problems ranges from 0 to 6 based on patients' reports that their physician does not always 1) give them enough time to explain the reason for the visit, 2) give answers to questions that are understandable, 3) take enough time to answer questions, 4) ask about how their family or living situation affects their health, 5) give as much medical information as they want, or 6) include them in decisions as much as they want.