How physician leaders look at the results of a survey on patient trust depends on whether they see the glass of water roughly one-fifth empty or four-fifths full.
Researchers at Brigham and Women's Hospital in Boston found that specialists in first encounters with their patients engender high levels of trust (79%), but that trust levels were lower for black patients (63%) than for whites (81%).
The survey was taken of 424 patients who had visited with a cardiologist, neurologist, nephrologist, gastroenterologist or rheumatologist they were seeing for the first time. For about 60% of the patients sampled, the encounter was the first time they'd ever seen a specialist of any kind.
"Even though an 80% level of trust is pretty good and is similar to the level in primary care, we could to better," said lead researcher Nancy Keating, M.D. "We haven't been as good as we should be in improving our communication skills."
The survey found that trust and communication went hand in hand. Those physicians who established higher levels of trust were also those whose patients said they had positive experiences: Their physician listened, they received as much information as they wanted, they were told what to do if problems persisted or worsened, they were involved in the decisionmaking as much as they wanted to be, and they had enough time with the physician.
"Physicians overestimate the amount of information they give patients and underestimate the amount that patients want," said Keating, a general internist at Brigham and Women's and a health services researcher in the Department of Healthcare Policy at Harvard University.
Keating says she realizes physicians are pressed for time and "the data is still out on the effectiveness of communication training," but even simple reminders, like checklists prompting physicians to remember to involve patients in decisionmaking and explain to them what to do if their condition worsens, would help.
Patient satisfaction surveys provide a good reality check. "If you don't ask, you don't know you have a problem," she said.