In Physicians we Trust

An article on a new physician trust measure in the recent issue of Annals of Family Medicine sparked some interesting commentary from Jessie Gruman. She challenged the idea of whether this was a measure of physician “trust” or good old-fashioned doctor-say patient-do. Using her personal experience with cancer, she explains her concerns about the article’s criteria being used to evaluate her doctor’s level of trust in her.

This is an interesting example of semantics, which is something we’ve been discussing here at the Center. Just as we ask the question, “How are we defining personalized medicine?” The same question applies here. “How are we defining physician trust?” Taken out of context, the Thom et al. Physician “Trust” measure sounds exactly as Jessie Gruman describes it – at best a paternalistic, non-participatory approach. But it’s important to remember the context in which the measure was used – HIV-positive patients on opiods for chronic, non-cancer related pain. Not cancer patients. These are two very dissimilar patient populations with significant differences in the social and cultural factors influencing their health behaviors and decisions. A scale designed for HIV-positive patients with chronic pain doesn’t make sense in an oncology setting and was never proposed by the authors.

That being said, I understand Gruman's gut reaction. The title of the Thom et al. article is misleading. Instead of “Physician Trust in the Patient,” the article title could have been: “Physician Trust in the HIV-positive Chronic Pain Patient” or “Physician Assessment of Abuse Potential in Chronic Pain of HIV-positive Patients.” And the issue of patient engagement remains. Despite the challenges these providers and patients are facing – namely, risk for drug abuse and addiction – these patients still need health care where they are involved in the process. Then a question like “How confident are you that the patient will follow the treatment plan you recommend?” might read something like: “How confident are you that you and your patient can develop a treatment plan together that the patient will follow?” It’s a subtle shift, but it brings the patient into the process of his/her care. It also attends to some of Gruman’s concerns. If nothing else, this is a perfect example where being clear in our terminology makes all the difference in how we interpret, understand, and utilize scientific information. We’ve still got a ways to go.