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.
Key words ambulatory care - trust - patient satisfaction - communication - patient-physician relationship
This work was funded in part by the Prudential Center for Health Care Research, Atlanta, Ga. The views expressed in this paper
do not necessarily reflect those of the funder. Dr. Keating was a recipient of a Harvard-Prudential Fellowship for Health
Services Reseach. During the conduct of this study, Dr. Cleary was a consultant to the Prudential Center for Health Care Research.
Since this study was conducted, Prudential HealthCare® has become a member company of Aetna U.S. Healthcare®, and the Prudential
Center for Health Care Research now operates as the Emory Center on Health Outcomes and Quality (formerly the USQA Center
for Health Care Research™).