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Why it matters

Trust is an essential part of a healthy doctor-patient relationship. Doctors need to trust that patients will provide relevant and accurate information about their health, and patients need to trust doctors’ clinical judgment about the tests and treatments they need – if any.

But trust isn’t a given. Trust is built over time, and trust can be lost. When trust isn’t present between a doctor and patient, how is care affected?

This study explores whether trust between doctors and patients – or the lack of it – has influenced recent increases in medical investigations and treatments. This is an important problem, because too much medicine – including too many tests and too low a threshold for intervention – could potentially harm patients’ health.

Our approach

By reviewing evidence about the nature of the doctor-patient relationship, we provide insight on how trust might influence doctors’ decision-making about ordering investigations or prescribing treatments.

Through relevant case studies, we illustrate the decision-making dilemmas doctors face when trust is in doubt.

We also investigate ways of building trust, and the potential for healthcare systems to facilitate trust-building to ensure that decisions about tests and treatments are made ethically.

What we found

  • Evidence suggests that more trust between doctors and patients could reduce the problem of too much medicine.
  • Questioning is important to building trust. The give and take of information can foster a relationship where both doctors and patients are happy.
  • Doctors can also build trust with their patients by being open about the uncertainties of diagnosis and treatment.
  • Trust between doctors and patients can be built through continuity of care, and it should be encouraged whenever possible.
  • New doctor-patient relationships are more likely to involve overprescribing than those where trust has developed over time.
  • Though ordering tests when they aren’t needed can help build trust, it may also expose patients to unnecessary harm.
  • Health systems can help avoid over-testing by encouraging more opportunities for follow-up and continuity of care.

Related content from our open-access series, Elements of Improving Quality and Safety in Healthcare

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