Trust between patients and physicians is a crucial part of health care systems worldwide; however, in China a lack of patient-physician trust has emerged as a growing problem, occasionally leading to violence against doctors. Recent and ongoing changes to the health care system in China make physician trust a topic of interest for policymakers, and previous research has investigated the deteriorating state of the patient-physician relationship in China. These studies have found several factors involved in this decline in trust, though the research has lacked reliable measurement tools and focused on small samples.
To gain a better understanding of patient-physician trust in China, Texas A&M School of Public Health Dean Jay Maddock and colleagues from the School of Public Health along with Dr. Wenxin Wang from Jiangsu University in China, studied a large sample of patients throughout China to measure levels of physician trust in China, investigate factors influencing those trust levels and explore those factors in subjects with extremely low trust levels. Their study published in the American Journal of Health Behavior gathered demographic data on more than 5,000 patients from 12 public hospitals in China and used the Wake Forest Physician Trust Scale to measure trust in physicians.
Low trust in physicians has been linked to perceived incompetence of medical providers, a lack of communication between providers and patients, and surgical complications. In addition to disputes, which have been linked to violence in a small portion of the population, a lack of trust can lead to decreased likelihood that patients will follow treatment plans, increased demand for additional tests and referrals and increased odds of poor health outcomes for patients.
The study used patients who were literate and fluent in Mandarin from 12 public hospitals selected from representative provinces in each of China’s three main regions. The researchers collected demographic data on each of the more than 5,000 subjects such as age, gender, ethnicity, income and education level. They also measured the subjects’ levels of trust toward physicians using the Wake Forest Physician Trust Scale, which has a composite score ranging from one to five, with one being the lowest level of trust and five being the highest.
Through their analysis, Dr. Maddock and colleagues found that overall trust in physicians in China is lower than in the U.S. with responses skewed toward the lower end of the trust score scale. Medical disputes are more likely in patients with lower physician trust levels, so understanding characteristics of lower-trust patients is crucial for health care reform efforts.
The researchers found that young male patients had lower levels of physician trust as did subjects with high levels of education and income. The income and education findings differ from previous research on physician trust in western countries, which the researchers state may be due to differences between health care systems in China and elsewhere. One possibility is that patients with higher incomes and education levels are more likely to have higher standards and expectations, in part due to being used to more exclusive access to care before recent reforms in China.
These findings point to a need to rebuild trust between physicians and patients and to address challenges with China’s health care system, such as the relatively minor role of primary care physicians and subsequent lack of long-term relationships between patients and medical providers. The researchers state that policymakers and other stakeholders, such as hospital administrators, should focus on populations found to have low levels of trust to inform health care system reforms and rebuild trust. Future research will also be needed to investigate these issues further by looking into non-hospital-based care and exploring relationships between physician trust scores and medical disputes and to inform efforts to build the trust between physicians and patients needed to make health care work.