Patient-physician relationships have been unintentionally deprioritized in current clinical practice. In turn, trust between physicians and patients is at risk, which may likewise increase patient vulnerability and reduce physicians’ perception of effective patient management, according to a viewpoint article published in JAMA.

Physician behavior is described as a critical component in improving trust, particularly if physicians consistently display empathy and honesty during care. Communication, knowledge of the patient, and the perception of the interpersonal relationship all play a role in trust.

According to the viewpoint article authors, research suggests that standard patient care evaluation should include measurements of trust and related issues in addition to assessments of care experiences and experiences with health plans. Doing so, leadership can develop insight into whether physicians are meeting expectations regarding the organization’s key values. In addition, individual clinicians should develop standards, training, and accountability systems that emphasize communication and relationship skills. Some hospitals have even begun providing their physicians with formal communication training.

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The viewpoint article also suggested that there should be an initial goal of having patients make choices regarding their preferences with appropriate clinical guidance, to improve the physician-patient relationship. Patients should also be made aware that they can have a navigator or translator available to ensure they understand what care they are receiving and whether that care meets with their preferences. It is also argued that patients in operational communities should be included. Senior management should be present at patient advisory council in an effort to have patients in the forefront of reducing the “erosion of trust” experienced by some patients.

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“The time has arrived for physicians, patients, other clinicians who provide care, and physician and non-physician executives of hospitals and insurance companies to mobilize around building trust,” the researchers concluded.


Lee TH, McGlynn EA, Safran DG. A framework for increasing trust between patients and the organizations that care for them [published online January 24, 2019]. JAMA. doi:10.1001/jama.2018.19186