Physicians' perspectives on building a trusting relationship with racially discordant patients

Background and Significance: Research has consistently shown that positive and trusting relationships between physicians and patients is associated with improved health behavior and health outcomes in patients. While several studies that examine trust in the patient-physician relationship have shown lower levels of trust in racially discordant patient-physician combinations, the majority of this work has been conducted from the patient's perspective. This study assesses the degree to which physicians work to build trusting relationships, particularly with racially discordant patients.

Objective: The purpose of this study was to identify characteristics of physicians who actively work to build trust with racially discordant patients.

Methods: We conducted a cross-sectional, web-based study with a random sample of board-certified, practicing general internists identified using the AMA Physician Masterfile (N=364). Logistic Regression was used to assess the likelihood of making an extra effort to build a trusting relationship with racially discordant patients. Covariates included physician characteristics (gender, race, age, practice setting), patient characteristics (% female, % minority, insurance status) and physicians' views on the relationships between race and genetics.

Results: Among responding general internists, 38% reported that they consider their patient's race all or most of the time because it contributes to the development of a trusting relationship. An additional 31% consider race some of the time for this reason. Over 50% of general internists reported that they made an extra effort to build a trusting relationship with racially discordant patients all or most of the time, while another 22% make an extra effort some of the time. We did not observe differences by physician gender (p=0.84), race (p=0.22), or practice setting (p=0.95). Further, we did not observe statistically significant differences based on physicians' racial and ethnic mix of patients.

Conclusions: Although previous work suggests that physician-patient race concordance greatly affects the trust relationship from the patient's viewpoint, our data provides a different perspective when assessing this relationship from the physician's viewpoint. Our work suggests that physicians do strive to build the trust of their patients. Further, it suggests that physicians' race, gender, racial and ethnic patient mix, and practice setting are not related to physician's putting forth an extra effort to build trusting relationships with racially discordant patients. Additional research is needed to further explore these findings and gain more insight on physicians' perspectives on the building trust with patients.