Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study

BMC Medical Education

Research Article

Robert A. Westbrook¹  Bich N. Dang²  Thomas P. Giordano²  Sarah M. Njue² 

[1] Jesse H. Jones Graduate School of Business, Rice University, Houston, TX, USA;VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA;Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, 77030, Houston, TX, USA;Department of Medicine, Baylor College of Medicine, Houston, TX, USA;

关键词: Patient satisfaction;    Patient-centered care;    Patient preference;    Physician-patient relations;    Patient engagement;    Health communication;    HIV infection;    Retention in care;    Qualitative studies;    Longitudinal studies;   

DOI  :  10.1186/s12909-017-0868-5

 received in 2016-05-18, accepted in 2017-01-24,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundNew patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Persons with HIV infection may be an ideal population to study the drivers of a positive initial patient-provider relationship, as it is a chronic and serious condition that requires a reliable, ongoing relationship with a provider. Informed by patients’ real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset.MethodsWe conducted longitudinal, in-person interviews with 21 patients new to the HIV clinic at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, from August 2013 to March 2015. Patients were interviewed across three time points: once before their first provider visit, a second time within two weeks after the first visit, and a third time at 6 to 12 months after the first provider visit.ResultsWe conducted 61 h of patient interviews. The mean age was 53 years; 52% were non-Hispanic white, 23% were non-Hispanic black and 19% were Hispanic. Patients described significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider. Our analysis of these experiences revealed five actions providers can take to reduce their patients’ anxiety and build trust early in the first visit: 1) provide reassurance to patients, 2) tell patients it’s okay to ask questions, 3) show patients their lab results and explain what they mean, 4) avoid language and behaviors that are judgmental of patients, and 5) ask patients what they want [i.e., treatment goals and preferences].ConclusionsOur study incorporates direct input from patients and highlights the unique psychological challenges that patients face in seeking care from a new provider. The actionable opportunities cited by patients have the potential to mitigate patients’ feelings of anxiety and vulnerability, and thereby improve their overall health care experience.

【 授权许可】

CC BY   
© The Author(s). 2017