How Are Patients' Specific Ambulatory Care Experiences Related to Trust, Satisfaction, and Considering Changing Physicians?

Authors

  • Nancy L. Keating MD, MPH,

    Corresponding author
    1. Received from the Division of General Internal Medicine, (Section on Health Services and Policy Research), Department of Medicine, Brigham and Women's Hospital (NLK), and the Department of Health Care Policy, Harvard Medical School (NLK, PDC, VYW), Boston, Mass; the Emory Center on Health Outcomes and Quality, formerly the USQA Center for Health Care Research™, (DCG, JAG), Atlanta, Ga; and the Institute for Ethics, American Medical Association (ACK), Chicago, Ill.
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  • Diane C. Green PhD, MPH,

    1. Received from the Division of General Internal Medicine, (Section on Health Services and Policy Research), Department of Medicine, Brigham and Women's Hospital (NLK), and the Department of Health Care Policy, Harvard Medical School (NLK, PDC, VYW), Boston, Mass; the Emory Center on Health Outcomes and Quality, formerly the USQA Center for Health Care Research™, (DCG, JAG), Atlanta, Ga; and the Institute for Ethics, American Medical Association (ACK), Chicago, Ill.
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  • Audiey C. Kao MD, PhD,

    1. Received from the Division of General Internal Medicine, (Section on Health Services and Policy Research), Department of Medicine, Brigham and Women's Hospital (NLK), and the Department of Health Care Policy, Harvard Medical School (NLK, PDC, VYW), Boston, Mass; the Emory Center on Health Outcomes and Quality, formerly the USQA Center for Health Care Research™, (DCG, JAG), Atlanta, Ga; and the Institute for Ethics, American Medical Association (ACK), Chicago, Ill.
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  • Julie A. Gazmararian PhD, MPH,

    1. Received from the Division of General Internal Medicine, (Section on Health Services and Policy Research), Department of Medicine, Brigham and Women's Hospital (NLK), and the Department of Health Care Policy, Harvard Medical School (NLK, PDC, VYW), Boston, Mass; the Emory Center on Health Outcomes and Quality, formerly the USQA Center for Health Care Research™, (DCG, JAG), Atlanta, Ga; and the Institute for Ethics, American Medical Association (ACK), Chicago, Ill.
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  • Vivian Y. Wu OTR, MS,

    1. Received from the Division of General Internal Medicine, (Section on Health Services and Policy Research), Department of Medicine, Brigham and Women's Hospital (NLK), and the Department of Health Care Policy, Harvard Medical School (NLK, PDC, VYW), Boston, Mass; the Emory Center on Health Outcomes and Quality, formerly the USQA Center for Health Care Research™, (DCG, JAG), Atlanta, Ga; and the Institute for Ethics, American Medical Association (ACK), Chicago, Ill.
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  • Paul D. Cleary PhD

    1. Received from the Division of General Internal Medicine, (Section on Health Services and Policy Research), Department of Medicine, Brigham and Women's Hospital (NLK), and the Department of Health Care Policy, Harvard Medical School (NLK, PDC, VYW), Boston, Mass; the Emory Center on Health Outcomes and Quality, formerly the USQA Center for Health Care Research™, (DCG, JAG), Atlanta, Ga; and the Institute for Ethics, American Medical Association (ACK), Chicago, Ill.
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Address correspondence and requests for reprints to Dr. Keating: Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115 (e-mail: keating@hcp.med.harvard.edu).

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.

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