Is there a moral duty for doctors to trust patients?
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In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors. (+info)
Facial resemblance enhances trust.
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Organisms are expected to be sensitive to cues of genetic relatedness when making decisions about social behaviour. Relatedness can be assessed in several ways, one of which is phenotype matching: the assessment of similarity between others' traits and either one's own traits or those of known relatives. One candidate cue of relatedness in humans is facial resemblance. Here, I report the effects of an experimental manipulation of facial resemblance in a two-person sequential trust game. Subjects were shown faces of ostensible playing partners manipulated to resemble either themselves or an unknown person. Resemblance to the subject's own face raised the incidence of trusting a partner, but had no effect on the incidence of selfish betrayals of the partner's trust. Control subjects playing with identical pictures failed to show such an effect. In a second experiment, resemblance of the playing partner to a familiar (famous) person had no effect on either trusting or betrayals of trust. (+info)
Patient trust in the physician: relationship to patient requests.
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BACKGROUND: Patient trust is a key component of the patient-physician relationship. A previous qualitative study has suggested that a low level of trust is associated with unfulfilled requests. OBJECTIVE: Our aim was to test the hypothesis that patients with a low level of trust will be more likely to report that requested or needed services were not provided during an office visit. METHODS: An observational study was carried out of office visits by 732 patients of 45 physicians (16 family physicians, 18 general internists and 11 cardiologists), within two managed care settings. Participants were consecutive, English-speaking patients, age 18 and older who had a significant health concern. Visit questionnaires were completed by 68% of patients known to be eligible. Post-visit measures included services requested (information, examination, prescription, test or referral); services provided; and requested or needed services not provided during the visit. Measures at 2-week follow-up included patient satisfaction, intended adherence to advice, interval contacts with the health system and symptom improvement. RESULTS: After adjustment for patient and physician characteristics, patient trust in the physician was not associated with the likelihood that a service was requested or provided during the visit, with the exception that prescription of a new medication was more frequent among patients with higher trust. In contrast, patients with low trust prior to the visit consistently were more likely to report that a needed or requested service was not provided (P < 0.001 for all services). Patients with a low level of trust were less satisfied with their care (P < 0.001), were less likely to intend to follow the doctor's advice (P < 0.001) and were less likely to report symptom improvement at 2 weeks (P = 0.03). CONCLUSIONS: Patients with a lower level of trust in their physician are more likely to report that requested or needed services are not provided. Understanding this relationship may lead to better ways of responding to patient requests that preserve or enhance patient trust, leading to better outcomes. (+info)
Prevention of HIV/AIDS in Native American communities: promising interventions.
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OBJECTIVE: This article presents the latest data on trends in AIDS prevalence among Native American men and women and discusses problems of classification, data collection, factors that contribute to high risk, and factors that affect prevention and intervention. It presents a model for building effective prevention and intervention strategies. OBSERVATIONS: The number of people in the United States diagnosed with AIDS has risen by less than 5% per year since 1992, and the slowdown is estimated to continue in coming years. Among Native Americans, however, the number of people diagnosed with AIDS rose 8% in 1997, and nonwhites accounted for more than one-half of all reported AIDS cases through December 2000. For Native Americans, the rate of growth in AIDS prevalence has been steadily increasing since the early 1980s, and AIDS is now the ninth leading killer of Native Americans between the ages of 15 and 44. Factors that contribute to high risk include poverty, homophobia, denial, and mistrust. CONCLUSIONS: Effective strategies must include efforts to reduce the risk factors for AIDS. Future research should honor and celebrate diversity among people as an empowering force that facilitates collaboration and shared learning with tribes. (+info)
Social trust and self-rated health in US communities: a multilevel analysis.
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This study assessed the contextual and individual effects of social trust on health. Methods consisted of a multilevel regression analysis of self-rated poor health among 21,456 individuals nested within 40 US communities included in the 2000 Social Capital Community Benchmark Survey. Controlling for demographic covariates, a strong income and education gradient was observed for self-rated health. Higher levels of community social trust were associated with a lower probability of reporting poor health. Individual demographic and socioeconomic predictors did not explain the association of community social trust with self-rated health. Controlling for individual trust perception, however, rendered the main effect of community social trust statistically insignificant, but a complex interaction effect was observed, such that the health-promoting effect of community social trust was significantly greater for high-trust individuals. For low-trust individuals, the effect of community social trust on self-rated health was the opposite. Using the latest data available on community social trust, we conclude that the role of community social trust in explaining average population health achievements and health inequalities is complex and is contingent on individual perceptions of social trust. Future multilevel investigations of social capital and population health should routinely consider the cross-level nature of community or neighborhood effects. (+info)
Trust in the medical profession: conceptual and measurement issues.
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OBJECTIVE: To develop and test a multi-item measure for general trust in physicians, in contrast with trust in a specific physician. DATA SOURCES: Random national telephone survey of 502 adult subjects with a regular physician and source of payment. STUDY DESIGN: Based on a multidimensional conceptual model, a large pool of candidate items was generated, tested, and revised using focus groups, expert reviewers, and pilot testing. The scale was analyzed for its factor structure, internal consistency, construct validity, and other psychometric properties. PRINCIPAL FINDINGS: The resulting 11-item scale measuring trust in physicians generally is consistent with most aspects of the conceptual model except that it does not include the dimension of confidentiality. This scale has a single-factor structure, good internal consistency (alpha = .89), and good response variability (range = 11-54; mean = 33.5; SD = 6.9). This scale is related to satisfaction with care, trust in one's physician, following doctors' recommendations, having no prior disputes with physicians, not having sought second opinions, and not having changed doctors. No association was found with race/ethnicity. While general trust and interpersonal trust are qualitatively similar, they are only moderately correlated with each other and general trust is substantially lower. CONCLUSIONS: Emerging research on patients' trust has focused on interpersonal trust in a specific, known physician. Trust in physicians in general is also important and differs significantly from interpersonal physician trust. General physician trust potentially has a strong influence on important behaviors and attitudes, and on the formation of interpersonal physician trust. (+info)
Credible threats and promises.
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We consider various implications of information about the other player in two-player evolutionary games. A simple model of desertion shows that information about the partner's behaviour can be disadvantageous, and highlights the idea of credible threats. We then discuss the general issue of whether the partner can convince the focal player that it will behave in a specific way, i.e. whether the focal player can make credible threats or promises. We show that when desertion decisions depend on reserves, a player can manipulate its reserves so as to create a credible threat of desertion. We then extend previous work on the evolution of trust and commitment, discussing conditions under which it is advantageous to assume that a partner will behave in a certain way even though it is not in its best interest. (+info)
Attitudes towards HPV testing: a qualitative study of beliefs among Indian, Pakistani, African-Caribbean and white British women in the UK.
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This study examined attitudes to human papillomavirus (HPV) testing among a purposively selected sample of women from four ethnic groups: white British, African Caribbean, Pakistani and Indian. The design was qualitative, using focus group discussion to elicit women's attitudes towards HPV testing in the context of cervical cancer prevention. The findings indicate that although some women welcomed the possible introduction of HPV testing, they were not fully aware of the sexually transmitted nature of cervical cancer and expressed anxiety, confusion and stigma about HPV as a sexually transmitted infection. The term 'wart virus', often used by medical professionals to describe high-risk HPV to women, appeared to exacerbate stigma and confusion. Testing positive for HPV raised concerns about women's sexual relationships in terms of trust, fidelity, blame and protection, particularly for women in long-term monogamous relationships. Participation in HPV testing also had the potential to communicate messages of distrust, infidelity and promiscuity to women's partners, family and community. Concern about the current lack of available information about HPV was clearly expressed and public education about HPV was seen as necessary for the whole community, not only women. The management of HPV within cervical screening raises important questions about informed participation. Our findings suggest that HPV testing has the potential to cause psychosocial harm to women and their partners and families. (+info)