Patients, if trust their doctors, are committed to them and this affects clinical outcomes. One thousand patients have been interviewed in family practice waiting rooms. family.jpg
Moving from the previous observation that patients show higher satisfaction scores if they usually visit the same doctor, a group of US physicians and business experts has investigated whether strength of patients’ commitment to their family physician was associated with adherence to prescriptions and healthy eating.
The report has been published in the January/February issue of the Annals of Family Medicine 1.

About a thousand patients have been administered a previously validated questionnaire in the waiting rooms of primary care clinics in Texas. Responses have been studied by a system of equations in which associations between patients’ trust of their doctor, physicians’ behaviours influencing trust, strength of patients’ commitment to doctors, adherence to therapy and presence of healthy food habits were analysed. The proposed statistical model fitted the data (remarkably, systemwide R2 was 0.72).

In other words, data show that patients’ trust is based not only on their opinion about physicians’ technical competence, but also on their perception of knowledge that doctors have of them and on their feeling to be supported in self-managing their own health.
Trust, in its turn, is correlated with patient-to-physician commitment, adherence to therapy and – ultimately – healthy eating. Authors conclude that “strength of [patient-physician] relationship is important” and it “is built not only from physicians’ medical competence, but also from their interpersonal behavioral competence”.

Authors themselves, however, point out that the clinical outcome they have chosen to consider (food habit) and the adherence to prescriptions are not objectively measured, but have been evaluated on the basis of patients’ responses. Moreover, waiting room interviews could present a selection bias, because patients who visit frequently their doctors could have been favoured. Beside these limitations, in my opinion the perspective from which authors have studied patient-to-doctor commitment is quite conditioned by the competence in marketing relationships of some of them.
It looks influenced by a “Tatossian-like” view, in which patient-physician relationship is included in a more general model of client-technician interaction, where the former requires a “repairing service” to the latter. The ability to appropriately build the relationship with the patient could be reduced, this way, to a mere “technical skill”.
It would be interesting to evaluate, together with patients’ perceptions, the role of physicians’ motivations.
Anyway, the findings of this study are worth of attention and stimulate more research in the directions that authors have opened.

Teodoro Marotta, Napoli

Local Health Unit “Napoli 1”, Naples

This email address is being protected from spambots. You need JavaScript enabled to view it.

1. Berry LL, Parish JT, Janakiraman R, Ogburn-Russel L, Couchman GR, Rayburn WL, Grisel J. Patient’s commitment to their primary physician and why it matters. Ann Fam Med 2008; 6: 6-13.

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