Changing medical organization and the erosion of trust.

Trust in medicine contributes to effective communication, cooperation in treatment, and the ability to cope with uncertainties. Social trust in medicine reflects public attitudes and is shaped by media and current events. Interpersonal trust depends on the degree to which patients see their doctors as competent, responsible, and caring. The commercialization of medical care, conflicts of interest, media attention to medical uncertainty and error, and the growth of managed care all challenge trust. Trust is encouraged by patient choice, continuity of care, and encounter time that allows, opportunities for feedback, patient instruction, and patient participation in decisions. An informal inquiry of medical leaders indicates that most believe trust is eroding. Institutions are taking measures to help restore trust: eliciting patient feedback; providing more information for patients are the public; improving staff education and sensitivity training; paying attention to clinicians' interpersonal skills; sponsoring support groups; instituting patient empowerment projects; and focusing on ethics issues.