Increase Patient Trust Research Articles

Treating Agitation in ER Requires Delicate Balancing Act

Treating Agitation in ER Requires Delicate Balancing Act

의료오류 공개에 대한 대학생들의 태도 조사*

Object: The purpose of this study was to identify the attitudes of patients regarding medical error. Methods: The questionnaires were administrated to 145 college students in Busan, one hundred twenty three usable 123 questionnaires were analyzed. The questionnaires consist of 4 major concepts; 1) knowledge, 2) attitudes toward disclosure of medical error, 3) expectations for doctors' behaviors, 4) barriers to the disclosure of the medical error. Results: Approximately 92% of respondents supported the immediate disclosure of medical errors, and 62.6% supported full disclosure including near misses. Approximately 57% believed that it would be most effective if doctors themselves communicated errors to patients, while almost 93% said that it was a doctor’s obligation to do so. Regarding reasons for disclosure, 44.7% said that it would reduce doctors’ feelings of guilt, while 45.5% said that it would also increase patient trust for doctors. Respondents also thought that the barriers to the full disclosure of medical errors were (1) damaged reputations (30.9%), (2) worries about medical lawsuits (22.8%), and (3) professional discipline (22.0%). Conclusion: Most of the participants in this survey support the immediate disclosure of medical errors regardless of the seriousness of the error. Furthermore the participants regarded disclosure of medical error as doctors' obligation. In order to meet the patients' high expectation regarding the medical error, this might be a good time for us to find a way to close the gap between patients' expectation and doctors' current practice.

A treatment decision aid may increase patient trust in the diabetes specialist. The Statin Choice randomized trial

Decision aids in practice may affect patient trust in the clinician, a requirement for optimal diabetes care. We sought to determine the impact of a decision aid to help patients with diabetes decide about statins (Statin Choice) on patients' trust in the clinician. We randomized 16 diabetologists and 98 patients with type 2 diabetes referred to a subspecialty diabetes clinic to use the Statin Choice decision aid or a patient pamphlet about dyslipidaemia, and then to receive these materials from either the clinician during the visit or a researcher prior to the visit. Providers and patients were blinded to the study hypothesis. Immediately after the clinical encounter, patients completed a survey including questions on trust (range 0 to total trust = 100), knowledge, and decisional conflict. Researchers reviewed videotaped encounters and assessed patient participation (using the OPTION scale) and visit length. Overall mean trust score was 91 (median 97.2, IQR 86, 100). After adjustment for patient characteristics, results suggested greater total trust (trust = 100) with the decision aid [odds ratio (OR) 1.77, 95% CI 0.94, 3.35]. Total trust was associated with knowledge (for each additional knowledge point, OR 1.3, 95% CI 1.1, 1.6), patient participation (for each additional point in the OPTION scale, OR 1.1, 95% CI 1.1, 1.2), and decisional conflict (for every 5-point decrease in conflict, OR 1.5, 95% CI 1.2, 1.9). Total trust was not associated with visit length, which the decision aid did not significantly affect. There was no significant effect interaction across the trial factors. Preliminary evidence suggests that decision aids do not have a large negative impact on trust in the physician and may increase trust through improvements in the decision-making process.

Reporting and Disclosing Medical Errors

To characterize pediatricians' attitudes and experiences regarding communicating about errors with the hospital and patients' families. Cross-sectional survey. St Louis, Mo, and Seattle, Wash. University-affiliated hospital and community pediatricians and pediatric residents. Anonymous 68-item survey (paper or Web-based) administered between July 2003 and March 2004. Physician attitudes and experiences about error communication. Four hundred thirty-nine pediatric attending physicians and 118 residents participated (62% response rate). Most respondents had been involved in an error (39%, serious; 72%, minor; 61%, near miss; 7%, none). Respondents endorsed reporting errors to the hospital (97%, serious; 90%, minor; 82%, near miss), but only 39% thought that current error reporting systems were adequate. Most pediatricians had used a formal error reporting mechanism, such as an incident report (65%), but many also used informal reporting mechanisms, such as telling a supervisor (47%) or senior physician (38%), and discussed errors with colleagues (72%). Respondents endorsed disclosing errors to patients' families (99%, serious; 90%, minor; 39%, near miss), and many had done so (36%, serious; 52%, minor). Residents were more likely than attending physicians to believe that disclosing a serious error would be difficult (96% vs 86%; P = .004) and to want disclosure training (69% vs 56%; P = .03). Pediatricians are willing to report errors to hospitals and disclose errors to patients' families but believe current reporting systems are inadequate and struggle with error disclosure. Improving error reporting systems and encouraging physicians to report near misses, as well as providing training in error disclosure, could help prevent future errors and increase patient trust.

Real-World Implementation of Evidence-Based Dental Practice

Fear of the unknown is well acknowledged as a human response rooted in the instinct for self preservation. Although this reaction may serve its purpose in certain specific contexts, it historically has proven to be a hindrance to progress in certain social domains. Ignorance in any form poses as a major obstacle of human progress via its thwarting effect on the intelligent response to what is not known. To vanquish ignorance is to gain insight and do away with fear. As the profession of dentistry continues to overcome its fear of the evidence-based approach to clinical practice via improved understanding and appreciation of this concept, so will its ability to implement its fundamentals. It can be said that through this gained insight will flow improved clinical evidence that in turn will facilitate better outcomes and increased patient trust and satisfaction. The profession’s informal reticence of the concepts of evidence-based practice the last few years has given way to the formal adoption of resolutions by state dental organizations and specifically by the American Dental Association in 2002: