Abstract:

Doctor-patient interpersonal trust refers to the expectant judgment and psychological state held by the physicians’ party and patients’ party, who both believe that one will not make unfavorable or harmful behaviors to the other. Although doctor-patient trust involves three levels including interpersonal trust, inter-group trust and institutional trust, the purpose of this article is to analyze the concept, the positive evolutionary process, and the antecedents of doctor-patient trust for the interpersonal trust level. Idealized evolution of doctor-patient interpersonal trust undertakes a gradually deepening process, from calculus-based trust to knowledge-based trust and then to identification-based trust. Characteristics of each evolutionary stage are as follows: In the early development stage of doctor-patient trust, the main psychological mechanism lies in the process of calculating benefit perception and risk perception. Trough the calculating process, patients decide whether to adhere to the medical advices or not, and doctors decide whether to take appropriate or defensive medical treatment measures. However, some doctor-patient relationships may just stop at the calculus-based trust stage. In the middle development stage, doctor-patient trust exhibits the characteristics of knowledge-based trust. Due to better understandings of each other, doctors reinforce their behaviors of taking appropriate medical treatment measures, while patients strengthen their behaviors of adhering to the medical advices. In the mature development stage, doctor-patient trust displays the characteristics of identification-based trust. The emotional status of individual satisfaction is formed through the process of comparing perception with expectation, and physicians’ satisfaction and patients’ satisfaction contribute to the maintenance of doctor-patient trust together. To be specific, patients compare the clinical efficacy perception with the clinical efficacy expectation to form the emotional status of patients’ satisfaction, while doctors compare the psychological contract with the performance perception of the psychological contract to form the emotional status of physicians’ satisfaction. However, only a few doctor-patient relationships can be enhanced from knowledge-based trust to identification-based trust. Only based on mutual understanding, one party develops identification with another party, especially when there exist strong emotions between the two parties, can this transformation take place. Although the identification-based trust is the most sable trust form of doctor-patient relationships, because doctor-patient interpersonal relationships are usually temporary, the identification-based trust which is built on emotion and identification is hard to form. This article summarizes the antecedents of doctor-patient trust, including social environment and values, treatment situations and individual characteristics. Doctor-patient trust crisis makes the asymmetry principle of trust more prominent in the doctor-patient relationships. The relationship-oriented values contribute to the relational trust orientation of the doctor-patient relationships in China. Levels of doctor-patient trust are significantly different between urban and rural medical institutions, different levels of hospitals and even hospital departments. Trust-oriented individual characteristics of patients mainly include social status, risk perceptions and emotions, while trust-oriented individual characteristics of doctors include competence and professional ethics. Based on the assumption of the positive evolutionary process of doctor-patient trust, further studies should collect longitudinal data to reveal the influencing mechanisms and developmental characteristics of doctor-patient trust, explore the dimensions of physicians’ trust and patients’ trust, and verify the specific mechanisms of doctor-patient trust on the two parties’ attitudes and behaviors.

摘要：

人际医患信任是人际水平上的医患信任, 是医患双方在互动过程中, 相信对方不会做出不利于自己甚至有害于自己行为的一种预期判断和心理状态。理想化的人际医患信任的正向演变可能呈现出由计算型信任到了解型信任, 再到认同型信任这一逐渐深化的过程。社会环境、就医情境与个体特征因素交互作用于医患信任建立与演变的心理机制与过程。未来研究应收集纵向数据探索医患信任的内容维度、影响机制及其演变特征, 并验证医患信任对于医患双方态度与行为的具体作用机制。