Clinician Mistrust in Patients: A Survey of Primary and Urgent Care Clinicians in Colorado.

Abstract

Background: Few studies have examined clinicians' mistrust in their patients. We explored this concept in greater detail.

Methods: We performed a survey (62.8% RR) of clinicians in primary and urgent care clinics at a university health system and a safety net health system in Denver, Colorado. The survey measured the frequency of clinician mistrust in patients, attitudes about mistrusting patients, perceived benefits and harms of mistrusting patients, and factors associated with mistrusting patients.

Results: On the survey virtually all clinicians (99.5%) indicated they mistrusted some patients, though the vast majority did so "Rarely" (70%) or "Sometimes" (28.6%). Most (57.5%) said it is sometimes ethical to mistrust patients, but 91.3% said mistrusting patients increases the risk of patients mistrusting them, 89% said it increases the risk of a negative patient review, and 68.2% said it might reduce the patient's future access to care. Clinicians attributed mistrust to patient-level behaviors and to institutional and societal factors. In a multivariable model, practicing in a safety net setting (OR 2.07, 95 CI 1.03-4.25) and feeling burned out (OR 2.51, 95 CI 1.02-6.48) were associated with higher odds of mistrusting patients, while spending less than 50% of professional time in clinical care was associated with lower odds (OR 0.20, 95 CI 0.05-0.62).

Conclusions: Most clinicians mistrust patients rarely or sometimes, and several institutional and societal factors contribute to this mistrust. Interventions to measure and improve trust in patient-clinician relationships should consider its bidirectional nature and how institutional and societal policy decisions can affect mistrust.