Public Trust and Initiatives for New Health Care Partnerships

Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08903, USA.
Milbank Quarterly (Impact Factor: 3.38). 02/1998; 76(2):281-302. DOI: 10.1111/1468-0009.00089
Source: PubMed


Effective communication between doctor and patient is a critical component of high-quality care. The physician's credibility has a significant effect on treatment outcomes. Because changes in medicine and larger cultural trends challenge the ability of clinicians to engage their patients' trust, new kinds of partnerships must be created. To do this effectively, physicians have to sharpen their communication skills and devise strategies for assuring that their patients become informed allies in their own treatment. A number of innovations are helping to build these alliances: training in communication skills; creative uses of the Internet and videotape technologies; improved "customer service" programs; critical pathways for patients; and special educational aids. All these tools promise to be useful, but they require careful development and evaluation.

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    • "Individual (interpersonal) level Individual (interpersonal) trust results from patients' experience of technical competence, knowledge and accountability (Baier 1986), as well as the concern, openness and reliability displayed by their physicians (Mechanic 1998). Patients' trust in their physicians correlates positively with the length of their relationship and satisfaction with their physicians, but awareness that physicians have incentives to behave opportunistically was found to produce mixed effects on patients' trust (Rhodes and Strain 2000). "
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    • "We do not know-nor do we routinely solicit-caregiver perspectives and input in our research and clinical endeavors. For us t o understand the black box between characteristics and outcomes (and to develop ecologically valid interventions), we must acknowledge caregivers as experts on the " realities of their daily lives " (Mechanic, 1998, p. 284). Thus, research and clinical intervention programs must incorporate strategies that embrace the unique, phenomenological experience of each individual caregiver. "
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    • "Increasingly accountability to citizens is being seen as a direct and local dynamic, rather than a 'vertical' and bureaucratic process (North & Werko 2002), even though in practice this ideal is difficult to achieve (Martin, 2008). Yet, ordinary public members are often disenfranchised from being able to contribute meaningfully to health reform (Mechanic, 1998; Taylor Gooby 2006) given the inevitable power dynamics associated with healthcare systems and policy processes (Kingdon, 1995; Mechanic, 1996; Pollitt & Bouckaert 2004). Clinicians who continue to hold high levels of public credibility (Calnan & Rowe 2008) can have an important role in shaping and revealing public views. "
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