Background: Trust has long been considered an important element in the doctor-patient relationship, and historically physicians have been considered one of the most trusted professions in the US. However, recent data suggests that patient trust in the healthcare system has eroded. One hypothesized cause of this loss of trust is the breakdown of the doctor-patient relationship resulting from discontinuity of inpatient care and the growth of hospitalists. The purpose of this study was to test for changes over time in patient’s trust with their inpatient physician, and to test whether certain patient demographic and/or system factors (i.e. hospitalist service) influence patients’ trust in their inpatient physician.
Methods: From 2006-2018 hospitalized adult medicine patients admitted were recruited into the University of Chicago Hospitalist Project research program. Patient’s consenting to participate were contacted by phone 30-days after hospital discharge and asked: “During your hospitalization did you have confidence and trust in the doctors treating you?“ Answer choices included 1) Yes, always, 2) Yes, Sometimes, and 3) No. Ordinal logistic regression was used to test for changes in patient trust as the dependent variable with the years 2006-2018, service designation (hospitalist-uncovered, general medicine housestaff-covered, hospitalist specialty co-managed), age, gender, race, length of stay (LOS), Charlson Comorbidity score, and insurance status as independent variables.
Results: 30,851 patients were consented and answered the 30-day follow up call. The average age of patients was 58 (±18); 59% were female; 73% were African American; and the average LOS was 5 (±6). Sixty-one percent (61%) of patients were cared for by a hospitalist-uncovered service, 24% by a general medicine housestaff-covered service, and 15% by a hospitalist on a specialty co-managed service. Fifty-two percent (52%) of patients had Medicare, 25% had Medicaid, 21% had private insurance, and 2% were uninsured. In the regression model, compared to younger adults (age <44) older adults were more likely to trust their physician (age 44-59 OR=1.3, p<0.001, 60-73 OR=1.4, p=<0.001, ≥74 OR=1.3, p=<0.001). Compared to male patients, females were less likely to trust their physician (OR=0.85, p<0.001). Compared to patients with a 1 day LOS, patients with ≥7 days LOS were less likely to trust their physician (OR=0.85, p=0.001). Compared to patients with Medicare, uninsured patients were more likely to trust their physician (OR=1.4, p=0.002). Compared to patients admitted to a general medicine housestaff-covered service, patients admitted to a hospitalist-uncovered service had no differences in physician trust, while patients admitted to a hospitalist specialty co-managed service were more likely to trust their physician (OR=1.2, p<0.001). Compared to 2012, there was a statistically significant decrease in trust in 2006 (OR=0.65, p=<0.001) and an increase in trust in 2013 (OR=1.20, p=0.01), but no other significant changes in trust during the study period.
Conclusions: Important demographic (age, gender, insurance) and hospital (LOS, service type) characteristics are associated with patient’s trust in their inpatient doctor. The decrease in trust in 2006 and the increase in 2013 may be due to unique institutional circumstances (new hospital affiliations, opening new hospital), but over the study years as hospitalists have increased the data do not support a decline in patient’s trust in their inpatient physician.