A preliminary mixed-method investigation of trust and hidden signals in medical consultations

PLoS One. 2014 Mar 11;9(3):e90941. doi: 10.1371/journal.pone.0090941. eCollection 2014.


Background: Several factors influence patients' trust, and trust influences the doctor-patient relationship. Recent literature has investigated the quality of the personal relationship and its dynamics by considering the role of communication and the elements that influence trust giving in the frame of general practitioner (GP) consultations.

Objective: We analysed certain aspects of the interaction between patients and GPs to understand trust formation and maintenance by focusing on communication channels. The impact of socio-demographic variables in trust relationships was also evaluated.

Method: A cross-sectional design using concurrent mixed qualitative and quantitative research methods was employed. One hundred adults were involved in a semi-structured interview composed of both qualitative and quantitative items for descriptive and exploratory purposes. The study was conducted in six community-based departments adjacent to primary care clinics in Trento, Italy.

Results: The findings revealed that patients trusted their GP to a high extent by relying on simple signals that were based on the quality of the one-to-one communication and on behavioural and relational patterns. Patients inferred the ability of their GP by adopting simple heuristics based mainly on the so-called social "honest signals" rather than on content-dependent features. Furthermore, socio-demographic variables affected trust: less literate and elderly people tended to trust more.

Conclusions: This study is unique in attempting to explore the role of simple signals in trust relationships within medical consultation: people shape trust and give meaning to their relationships through a powerful channel of communication that orbits not around words but around social relations. The findings have implications for both clinicians and researchers. For doctors, these results suggest a way of thinking about encounters with patients. For researchers, the findings underline the importance of analysing some new key factors around trust for future investigations in medical practice and education.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Communication*
  • Cross-Sectional Studies
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Physician-Patient Relations*
  • Qualitative Research
  • Referral and Consultation*
  • Risk Factors
  • Surveys and Questionnaires
  • Trust*
  • Young Adult

Grants and funding

This research was supported in part by the Department for Adaptive Behaviour and Cognition, Max Planck Institute for Human Development, Königin-Luise-Straße 5,14195, Berlin, Germany for the use of informatics software (Unipark) and by a grant from the lending institution La Cassa Rurale Giudicarie Valsabbia Paganella, (P.Iva 00158520221), Trento Province (Italy). Regulatory affairs and administration details on of the project can be asked directly via website at http://www.lacassarurale.it/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.