The Relationship Between the Physician-Patient Relationship, Physician Empathy, and Patient Trust

Abstract

Background: A trusting physician-patient relationship is an essential component of high-quality care.

Objective: To explore the relationship between the physician-patient relationship, physician empathy, and patient trust.

Design: Cross-sectional survey.

Participants: A total of 3289 patients (response rate 68.6%) from 103 hospitals in eastern, central, and western China completed surveys.

Main measure: Physician empathy, patient trust, and physician-patient relationship were measured by the Chinese version of Consultation and Relational Empathy Scale, Wake Forest Physician Trust Scale, and Patient-Doctor Relationship Questionnaire, respectively. Bootstrapped mediation analysis was performed.

Key results: There were moderate to strong correlations between physician empathy, patient overall trust, and patient trust in physician's benevolence and competence, and the physician-patient relationship (r = 0.49-0.75, P < 0.01 for all). Patients' evaluation of physician-patient relationship was predicted by their perception of physician empathy, patient overall trust, and trust in the physician's benevolence. Mediation analysis showed that the indirect effect of physician empathy on physician-patient relationship through patient overall trust was significant (β = 0.18, 95% CI: 0.15-0.21) and that the mediation effect of patient trust in physician's benevolence was significant (β = 0.24, 95% CI: 0.20-0.28), though the mediation effect of patient trust in physician's competence was not (β = 0.01, 95% CI: -0.02 to 0.02).

Conclusions: Patients' perception of physician empathy influences their evaluation of the physician-patient relationship both directly and indirectly via patient trust in the physician's benevolence. These findings underline the importance of patient belief in physician benevolence and empathy in building trustful and harmonious relationships between physicians and patients.

Keywords: benevolence; competence; patient trust; physician empathy; physician-patient relationship.

Figure 1

Mediation results of physician empathy on physician-patient relationship through patient overall trust in physician. All paths are presented in standardized regression coefficients. The indirect path ab is a product of the a path and b path. ^***p < 0.001. Direct effect=c: β=0.56, SE=0.017, 95% CI: 0.53–0.60. Indirect effect=ab: β=0.18, SE=0.014, 95% CI: 0.15–0.21. Total effect=ab+c: β=0.74, SE=0.014, 95% CI: 0.72–0.77.

Figure 2

Mediation results of physician empathy on physician-patient relationship through patient trust in physician’s benevolence. All paths are presented in standardized regression coefficients. The indirect path a₁b₁ is a product of the a₁ path and b₁ path. ^***p < 0.001. Direct effect=c’: β=0.50, SE=0.018, 95% CI: 0.47–0.54. Indirect effect—Trust in benevolence=a₁b₁: β=0.24, SE=0.019, 95% CI: 0.20–0.28. Trust in competence=a₂b₂: β=0.01, SE=0.010, 95% CI: −0.02–0.02. Total effect= a₁b₁+c’: β=0.74, SE=0.014, 95% CI: 0.72–0.77.