Trust is central to relationships between patients and health care providers. Patients who are more trusting of their providers tend to be more satisfied with their treatment, behave in ways that are more beneficial to their health, report fewer symptoms and have a higher quality of life.

Research and interventions related to trust overwhelmingly focus on patients’ trust in physicians. But trust should be reciprocal in order to facilitate sustained physician-patient partnerships.  Physicians need to trust their patients to provide reliable information, participate in complex and potentially high-stakes decisions and follow treatment plans.

This research compares the views of people insured by Medicaid and primary care doctors who treat people with Medicaid regarding how to build mutual trust. The research involved representative surveys of each population and separate focus groups with each population. This research was supported by a grant from the Robert Wood Johnson Foundation.

Key Findings Include:

  1. Primary care doctors and people with Medicaid agree that trust should be mutual. Both feel equally responsible for building it and both feel that it takes time to develop. Doctors overwhelmingly trust patients with Medicaid unless that trust is broken. But more people with Medicaid express wariness, with nearly 4 in 10 saying doctors need to earn their trust.
  2. Primary care doctors and people with Medicaid agree that in order for doctors to gain patients’ trust, good listening and communication are top priorities. But the two groups have different priorities regarding other ways doctors can gain patients’ trust. People with Medicaid prioritize doctors following basic safety protocols, while doctors think it is more important to consider their patients’ finances and lifestyles. Few people with Medicaid say that a doctor’s race or gender affects their trust.
  3. Nearly 4 in 10 people with Medicaid say they have been treated by a primary care doctor whom they did not trust. Most people who have had those negative experiences say that as a result, they have behaved in ways that could negatively affect their health, such as stopping medications or delaying care. More of those who have been treated by a doctor they did not trust also say they have behaved in ways that could damage doctors’ trust in them.
  4. Primary care doctors largely feel that patients with Medicaid are just as trustworthy as patients with other types of insurance. But when patients with Medicaid are actively engaged in their care, such as by participating in decisions or voicing their health goals, primary care doctors trust them more. These doctors are less trusting, however, when patients with Medicaid leave out information, exaggerate symptoms or insist on specific treatments.