The Study Of Trust In The Relationship Between Doctors And Patients

Trust is the basis for the establishment and maintenance of doctor-patient relationship.With trust,there will be a harmonious and healthy relationship between doctors and patients;without trust,there will be a lot of conflicts between doctors and patients.The trust between doctors and patients mainly emphasizes the patient’s trust in the doctor(Hereinafter refers to as "patient trust"),the patient’s trust to the doctor is the intrinsic value of the doctor-patient relationship,and it is the link between doctors and patients.Study on patient trust is not only beneficial to improve the theoretical system of public health services,enrich the treasure house of sociology and social psychology theory,it is also conducive to the protection of the basic rights and interests of doctors and patients,and promote the harmonious development of society.This study is a combination of quantitative and qualitative research,theoretical and empirical research.The research idea is to review and sum up the research of patients’trust at home and abroad with the tension of the doctor-patient relationship as the breakthrough point,combined with the CSS2013 questionnaire to determine the research theme.Based on the content of the questionnaire,combined with the existing theoretical experience and practical experience,the interview outline was set up,and the data were collected through interviews(a total of 47 cases).Finally,dispose the doctor-patient trust from the point of the patient,then give a comprehensive description of the status quo of patients’ trust in our country and the reasons for the crisis of confidence in patients,then propose the corresponding solutions on the basis.The aim of this study was to start from the perspectives of subject,object and environment,on the basis of concept definition of "patients’ trust in doctors",through the empirical study,to analyze the current situation of patients’ trust in doctors,to explain the occurrence reasons of trust crisis between doctors and patients,and to discuss how to build the trust system.Specifically,the first is the analysis of the current situation of patient trust.This study analyzed the overall trust condition of patient trust,and made the overlapping analysis on how various factors affect the degree of patients’ trust in doctors,such as gender,age,education level,marital status,political status,accounts nature,the types of residential areas,work situation,and so on.The second is the analysis of the relationship between the subject of trust and the patient trust.This study analyzed that how various factors affect the degree of patients’trust in doctors including health satisfaction degree,medical insurance,financial situation,medical payment pressure,emotion,medical procedure,and so on.The third is the analysis of the relationship between the object of trust and the patient trust.This study analyzed that how various factors affect the degree of patients’ trust in doctors including the types of hospital,the levels of hospitals,medical experience,healthcare satisfaction,and so on.The fourth is the analysis of the relationship between the trust environment and the patient trust.This study analyzed that how various factors affect the degree of patients’ trust in doctors including medical security,medical equity,medical security,satisfaction degree with the medical service provided by government,whole social trust level,and so on.Fifth,the improvement and adjustment of patient trust.This study discussed the improvement and adjustment of patient trust from multiple perspectives such as institutional mismanagement,medical security,information communication,trust environment,and so on.The study found that 64.6%of respondents relatively trust doctors,18.9%of respondents trust doctors very much,1.5%of respondents completely distrust doctors,and 13.0%of respondents relatively distrust doctors.After the disposing of missing values,the respondents who have high degree of trust in doctors account for 85.5%of all respondents,and the respondents who have low degree of trust in doctors account for 14.5%of all respondents.There are some related reasons behind the high trust.For example,the subjects selected for this research are those who have seen the doctor at medical institution in recent years.This part of groups are(or were)patients of a doctor,and they have high degree of trust in doctors,so they can succeed in completing the treatment.Certainly,it is possible that the degree of patient trust is false high due to the passivity and blindness of patient trust.In consideration of the significant complexity of various factors including patients themselves,doctors,medical environment,whole social trust level,we should not judge the harmony of doctor-patient relationship simply by using "trust" and "distrust".The biggest problem of doctor-patient relationship in China is not only including the question of trust or not,but also including the hidden danger behind the trust.For example,using the high degree of patient’s trust,the doctor may prescribe some drugs and tests which are expensive and with high sales commission but maybe do not have a good effect.The patients trusting doctors too much may lull the doctors into a false sense that the patients do not know anything and are gullible.Generally,there are three kinds of situations about betraying patient’s trust:the doctor does not have the ability to diagnose the illness for patient or he does not diagnose the illness on purpose,therefore,maybe after many tests it is found that the patient just get a small illness;the doctor does not explain the case to patient on purpose,and in fact the patient just get a small illness,but the doctor prescribe various drugs;the patient know his condition is not serious,but the doctor still prescribe a lot of expensive drugs.There are mainly four kinds of relationships between patient and doctor:trust,distrust,deceive,and do not deceive(sincerely treat).The game of trust and deceit is often being played between patients and doctors.The qualitative data showed that the subject of trust,the object of trust and the environment of trust affected patient’s trust.Subject Factors mainly include health satisfaction degree,medical insurance situation,financial situation,medical payment situation,emotion,medical procedure,and so on.Object factors mainly include the type of medical institution where the respondent sought medical care,the problem of difficulty getting medical service,healthcare satisfaction,and so on.Trust environment mainly includes medical system environment and social trust environment.Medical system environment mainly includes the satisfaction degree with medical insurance,the equity level of public health,the degree of medical safety,whether the medical and health services provided by the local government are good or not,and so on.Social trust environment mainly includes interpersonal trust and institutional trust.Binary logistic regression analysis showed that,the higher the respondents’ health satisfaction degree,the more they trust doctors,otherwise the more they distrust doctors.If the gross incomes of respondents are less than or equal to 10000 yuan,they tend to distrust doctors,otherwise they tend to trust doctors.The better the family finances of the respondents,the higher the degree of their trust in doctors,otherwise the lower the degree of their trust in doctors.If the respondents and their families have the problem that they cannot afford the medical expenditure,they tend to trust doctors;otherwise they tend to distrust doctors.The better the emotional state of work,the higher the degree of their trust in doctors,otherwise the lower the degree of their trust in doctors.The respondents and their families who have seen the doctor in the past year have higher degree of trust in doctors than those who have not seen the doctor in the past year.People do not care the bad experience of giving treats and gifts;they care if the doctor can get things done after acceptance of treats and gifts.Based on the level of medical institutions,the higher the level of medical institution where the respondents seek medical care,the more they distrust doctors,conversely,the lower the level of medical institutions,the more they trust doctors.The less serious the respondents consider the problem of difficulty getting medical service,the more they trust doctors,otherwise the more they distrust doctors.The more satisfied respondents are with the course of seeking medical care,the more they trust doctors,otherwise the more they distrust doctors.Based on the types of medical institutions(public medical institutions and non-public medical institutions),"the type of medical institution" has no significant influence on the degree of patients,trust in doctors(the dependent variable).The easier the respondents consider getting medical service,the more they trust doctors,otherwise the more they distrust doctors.The more satisfied respondents are with the course of seeking medical care,the more they trust doctors,otherwise the more they distrust doctors.The more fair the respondents consider the public health,the more they trust doctors.The higher the respondents consider the degree of medical safety,the more they trust doctors.The better the respondents consider the medical and health services provided by the government,the more they trust doctors.The higher value assigned to institutional trust factor,the more the patients trust doctors.The higher value assigned to interpersonal trust factor,the more the patients trust doctors.Currently,the tension of doctor-patient relationship in our country is not caused by a single factor;whereas it is the result of comprehensive effects of multiple factors,including the reasons in macroscopic social background level(social transformation),the consequences in mesoscopic institutional level(professional environment of medicine),the effects in microscopic individual level(emotional behaviors of doctors,patients and their families)and the specific situation of medical treatment.Accordingly,to solve this problem also needs to start from different aspects.On this basis,the author describes this research from the following four kinds of paths and puts forward countermeasures and suggestions on how to relieve the tension of doctor-patient relationship in our country and build trust of patients.The first aspect is the route analysis in management institutional level.In government management,it needs to increase institutional and financial support for medical and health services,promote fair distribution of medical and health resources,build and improve the legal system of health affairs,and deepen the reform of medical and health services.In hospital management,it needs to strengthen the management of medical prices,medical process and hospital culture,build and improve the evaluation mechanism for health care workers.In supervision system,it needs to improve the existing supervision system and pay much attention to the power of social supervision.The second aspect is the route analysis in medical security level.It not only needs to deepen the medical security reform to improve coverage,medical security level and fairness,but also needs to innovate in the medical security model to ease tension of doctor-patient relationship.The innovations of medical security model mainly include the family doctor system and community health management model.The third aspect is the route analysis in information communication level.In terms of communication skills between patients and doctors,for doctors,it needs to pay attention to communication skills such as receptive listening,full acceptance,timely response,and so on.For patients,on the one hand,patients and their families need to understand that the doctors cannot do everything and it is impossible to cure all diseases in the world.So,the patients should adjust their expectation to meet the current level of medical technology.On the other hand,in the course of treatment,if the patient finds the doctor makes any suggestion that go against the common sense of medical science,or offers any unnecessary test or drug,they can directly refused,rather than the "blind loyalty" to doctor.In terms of medical social workers involvement,medical social workers should assist the cultural management of hospital,enhance the moral quality of medical workers and provide communication skills training for them.Medical social workers should perform interventions for doctors currently involved in medical accident disputes or once involved in medical accident disputes and have not stepped out from the shadows.They also should perform interventions for special patients and their families,mainly adopting the method of case work.The fourth aspect is the route analysis in trust environment level.In terms of the construction of whole social trust environment,it needs to trace the human nature,pay attention to the construction of interpersonal trust system and institutional trust system,and foster good social trust culture.In terms of the construction of trust environment in medical field,it needs to discuss from multiple perspectives such as the patients,the doctors,the bridge,the government,the news media,and so on.