This article by Rose Wiles also appears in the MethodsNews Spring 2014 issue.
Trust is fundamental in relationships where there is an element of risk and unequal knowledge between parties, such as in the relationship between a patient and their GP. While 'general' measures of trust in GPs in surveys demonstrate high levels of trust among populations, 'specific' measures of trust (in relation to particular experiences of health care) reveal a more sceptical picture, particularly among people with certain health conditions.
Various factors have been identified as challenging the trust that people have traditionally had in GPs. These include an increase in the availability of health information and support online, an increase in the prevalence of chronic conditions, and a decline in levels of trust in science and public organisations in general, and in the medical profession in particular. The nature of patient-doctor interactions are further complicated by the Health and Social Care Act (HSCA) 2012. Various health care organisations have argued that the Act poses a further threat to trust between patients and GPs, as GPs take on a major budgetary role. The relationship between GPs and patients has been characterised as changing from one of 'blind' or 'embodied' trust in GPs, in which patients unquestionably view their GP as trustworthy, to one of 'earned trust'. The earned trust model implies that patients trust their GPs when their personal experience with a GP indicates that they are trustworthy, that is, when they demonstrate their technical competence as well as a range of interpersonal skills.
NCRM researchers have been exploring trust in GP/patient relationships using a mixed methods approach involving analysis of the 2012 GP-Patient Survey, focus groups with users of GP services and analysis of on-line patient forums Analysis of the 2012 GP-Patient Survey found that lower levels of trust were associated with patients with the following conditions: long-term neurological problems; long-term back problems; long-term mental health conditions; arthritis or long-term joint problem; epilepsy; kidney or liver disease. In addition to these conditions, our analysis also found an association between people with visual or hearing impairment and dissatisfaction with their GPs in some of the behaviours that have been associated with relationships of trust between patients and GPs, such as giving time to patients and listening to them.
Focus group participants and analysis of data from online forums identified issues relating to GPs' technical competence, their communication skills and their interpersonal skills or characteristics in describing what defined a trustworthy GP. Each of these attributes was linked to each other so a trustworthy GP was viewed as needing skills in each of these domains. Participants viewed a trustworthy GP as one who treats their condition appropriately, who 'knows' them and has knowledge about their life, who treats them as an individual and who they can have access to at a time when they need it.
Underlying patients' conceptions of the behaviour and characteristics of a trustworthy GP appears to be an ideal of the family doctor of the past. In discussing the trustworthiness of GPs, participants drew on two distinct types of GP; that of the family doctor and the doctor who is a manager of a business. The former was seen as trustworthy and as someone who acted in the best interests of their patients and the latter as someone who acted in the best interests of the 'business'. The many demands on GPs, exacerbated by the HSCA, mean that a return to this ideal of a GP as a 'family doctor' is unlikely and probably impossible. Many of the participants to this study were aware of this and regretted the move to bureaucratic and rationalised general practice.
Our research indicated that there are many barriers in contemporary general practice that make it difficult to develop the sorts of relationships of trust that patients seek. However, despite this, some research participants appeared to have been able to forge relationships of trust with their GPs with which they were satisfied, demonstrating that such relationships are possible despite the constraints patients and GPs experience.
Download the working paper: Wiles, R. 2014. Trust in GPs: Findings from Focus Groups