Patients With High Medical Costs Less Likely To Trust Their Docs

A paper in the current issue of the Journal of General Internal Medicine reports that the rising cost of medical care threatens a vital aspect of the effective delivery of medical care—patient trust in their physician and continuity of care. This study found that patients with high medical cost burdens were more likely to question whether their physician would put their needs first, would refer them to specialists when needed and would perform unnecessary tests. Patients with high medical cost burdens also had more negative assessments of the thoroughness of care they receive from their physician. The association of high medical cost burdens with patient trust and perceived quality of care was greatest for privately insured people.

Other studies have suggested that patients and their doctors each play a part in creating this situation. For example in his book "How Doctors Think" Dr. Jerome Groopman points out that when working with a patient with multiple conditions doctors often tend to focus on the first one the patient talks about, and minimize the importance, or inter-relationship, of the others. This can cause the patient to doubt that the doctor is looking at their total situation. On the other hand, patients burdened with high medical costs are likely spending more time with doctors than the general population and be more involved in the specfic details of their care than the general population. As a result they may have expectations about the care they receive that healtheir individuals don't have.