Physician Perspectives Research Articles

Physician perspective on the implementation of risk mitigation strategies when prescribing opioid medications: a qualitative analysis

ObjectiveTo understand the physician perspective on the barriers and facilitators of implementing nine different opioid risk mitigation strategies (RMS) when prescribing opioid medications.MethodsWe created and dispersed a cross-sectional online survey through the Qualtrics© data collection platform among a nationwide sample of physicians licensed to practice medicine in the United States who have prescribed an opioid medication within the past year. The responses were analyzed using a deductive thematic analysis approach based on the Consolidated Framework for Implementation Research (CFIR) to ensure a holistic approach to identifying the barriers and facilitators for each RMS assessed. In concordance with this method, the themes and codes for the thematic analysis were defined prior to the analysis. The five domains within the CFIR were used as themes and the 39 nested constructs were treated as the codes. Two members of the research team independently coded the transcripts and discussed points of disagreement until consensus was reached. All analyses were conducted in ATLAS.ti© V7.ResultsThe completion rate for this survey was 85.1% with 273 participant responses eligible for analysis. Intercoder reliability was calculated to be 82%. Deductive thematic analysis yielded 2,077 descriptions of factors affecting implementation of the nine RMS. The most salient code across all RMS was Knowledge and Beliefs about the Intervention, which refers to individuals’ attitudes towards and value placed on the intervention. Patient Needs and Resources, a code referring to the extent to which patient needs are known and prioritized by the organization, also emerged as a salient code. The physicians agreed that the patient perspective on the issue is vital to the uptake of each of the RMS.ConclusionsThis deductive thematic analysis identified key points for actionable intervention across the nine RMS assessed and established the importance of patient concordance with physicians when deciding on a course of treatment.

Constipation in Patients With Chronic Kidney Disease.

Constipation is a frequent symptom in patients with chronic kidney disease (CKD). This review outlines the mechanisms and management of constipation in patients with CKD from a physician's perspective. Common causes of constipation in patients with CKD include concomitant medications, low dietary fiber intake, water-restricted diet, lack of physical activity, altered gut microbiota, and reduced gastrointestinal motility. Constipation has a negative impact on overall health, and, in particular, the presence of constipation has been associated with worsening kidney function and increased risk of developing advanced stages of CKD. Although lifestyle and dietary modifications may not always be practical for patients with CKD, they are recommended because they are beneficial as they lower mortality in patients with CKD. The use of laxatives containing magnesium salts, bulking agents, and osmotic laxatives may have insufficient efficacy and may be associated with adverse effects. In contrast, lactulose and lubiprostone have been shown to exhibit reno-protective effects. Linaclotide and plecanatide have very limited systemic absorption and appear safe in patients with CKD. Tenapanor reduces paracellular intestinal phosphate absorption in addition to blocking sodium uptake by enterocytes, and provides additional benefit in patients patients with CKD who have hyperphosphatemia and constipation. Prucalopride leads to improvements in bowel function and constipation-related symptoms in cases in which response to conventional laxatives are inadequate. However, the dose of prucalopride should be reduced to 1 mg once daily for patients with CKD. In conclusion, there are important advances on the impact and treatment of constipation in patients with CKD.

Understanding the influence of medical education on physician geographic disposition: A qualitative study of family physician perspectives in Canada

AbstractRationalePrimary care access challenges are experienced by many communities. In several jurisdictions, including Canada, family physicians (FP) have the professional autonomy to organize their practice in alignment with professional and personal interests. Although system‐level interventions are tremendously important, investment in upstream interventions associated with the medical education of graduating FPs is a promising strategy for ameliorating primary healthcare access challenges.Aims and ObjectivesThis study investigates the medical education experiences that influence FP's decisions about practice locations in Canada.MethodsWe conducted semistructured interviews with FPs who completed undergraduate and postgraduate medical training in Canada and now have a practice in Ontario, Canada. Interview data were coded and analysed using an unconstrained descriptive approach.ResultsFPs preferred practice locations are intimately tied to their desired practice scope. Practice preferences were shaped through training experiences with patient populations, heightened clinical responsibilities, practice models and locations, professional mentorships and networks. Proximity to family, partner and lifestyle preferences, cultural connections and the available practice opportunities also shaped practice location decisions.ConclusionMedical education influences the identification and refinement of professional family practice preferences. Health workforce policies and interventions should leverage medical education to promote more equitable primary healthcare access.

Matching-Adjusted Indirect Comparison of the Long-Term Efficacy Maintenance and Adverse Event Rates of Lebrikizumab versus Dupilumab in Moderate-to-Severe Atopic Dermatitis.

Lebrikizumab and dupilumab are monoclonal antibodies approved for treating moderate-to-severe atopic dermatitis (AD). Both have demonstrated efficacy and safety over the 16-week SOLOs and ADvocate trials. However, AD is a chronic and relapsing inflammatory disease, and the long-term maintenance of efficacy is critical for achieving disease control from the perspective of patients, physicians, and regulatory agencies. This study aims to compare the long-term efficacy and safety of lebrikizumab every 4weeks (Q4W) and dupilumab every week or every 2weeks (QW/Q2W) among adult patients who have achieved treatment efficacy following the induction period of 16weeks. Lebrikizumab's efficacy was assessed using individual patient data (IPD) from the ADvocate 1 and 2 monotherapy trials. Dupilumab's efficacy was evaluated using aggregate data from the adult-exclusive SOLO-CONTINUE trial. Due to the absence of a common comparator trial arm, we employed an unanchored matching-adjusted indirect comparison (MAIC), a robust methodology widely accepted by health technology assessment (HTA) agencies. This re-weights ADvocate IPD to align with SOLO-CONTINUE's prognostic factors and effect modifiers. We compared lebrikizumab's adjusted outcomes with dupilumab outcomes at week52, focusing on 75% improvement in the Eczema Area and Severity Index from baseline (EASI-75), Investigator's Global Assessment (IGA) score of 0 or 1, and overall adverse event (AE) rates. Sensitivity analyses were conducted to test various combinations of matching variables. Adults on lebrikizumab Q4W were more likely to maintain IGA 0/1 through the 36-week maintenance period (weeks16-52) compared with those on dupilumab QW/Q2W [risk ratio (RR) 1.334; 95% confidence interval (CI) 1.02-1.74; p = 0.035]. Both treatments demonstrated comparable efficacy in terms of EASI-75 maintenance (RR 0.937; 95% CI 0.78-1.13; p = 0.490) and similar AE rates (RR 1.052; 95% CI 0.90-1.23; p = 0.526). Sensitivity analyses substantiated these findings. Our findings suggest that lebrikizumab Q4W may provide equal or superior long-term maintenance of efficacy measured with EASI-75 and IGA 0/1 compared with dupilumab QW/Q2W, with the advantage of requiring less frequent doses.

Chronic Rhinosinusitis with Nasal Polyps: A Survey on Routine Management and Evaluation of Disease Control in Practice.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a significant impact on quality of life. The overall goal of CRSwNP management, as with other chronic conditions, is to achieve "disease control", and for that reason, a definition of control of disease is pivotal in deciding the best treatment strategy. Although many staging systems have already been developed to evaluate the disease, disease control is not yet to be standardized, and a specific tool that is consistently applied and accepted by all practitioners is still missing in daily clinical practice. To gain an overview of the implementation and limitations of existing guidelines and to shed light on real-life definitions of control and disease severity, we conducted a nationwide survey of otorhinolaryngologists routinely treating CRSwNP to identify unmet clinical needs in Italy. The results showed homogeneous responses regarding the knowledge contained in international guidelines while highlighting the difficulty of their implementation in day-to-day practice. Respondents called attention to the importance of clinical symptoms, giving more weight to the patient's perspective. Among the symptoms to be considered, respondents emphasized nasal obstruction, followed by loss of sense of smell and rhinorrhea. Others also believe that the physician's perspective should be considered, and the inclusion of endoscopy as a measure of control was warranted by many. The need for a specific tool that is able to unequivocally ascertain disease control is increasingly pivotal in this new era of biologics for treating CRSwNP.

The use of social media in the self-management of chronic diseases: views of patients and doctors

Abstract Background Despite the deep integration of social media into daily self-management practices of people living with chronic conditions, there are still conflicting opinions about the role of social media in disease self-management. Comparing the perspectives of patients and physicians is useful in understanding potential tensions and facilitating more effective collaboration between patients and physicians. The aim of the research was to find out the opinions of patients and doctors about the benefits and risks of using social media for disease self-management. Methods We used mixed methods convergent parallel design combined an internet survey and in-depth interviewing. We collected data from online questionnaire posted in online communities for people with chronic diseases on social media platforms Vkontakte and Facebook (N 204). The qualitative phase used in-depth interviews with doctors (N 23). We analyzed quantitative data in SPSS and qualitative data in Nvivo. Results From the perspective of patients, the main benefits include access to information about treatment through peer-to-peer expertise (70,8%) and sharing personal experience of disease (60,9 %). Patients indicated risks of unproved information (92,2%) and breach of anonymity (71,5%). All interviewed doctors were skeptical about benefits of the use of social media by patients. They see the main risks in the dissemination of unreliable and unqualified information about treatment and the destruction of the usual patterns of doctor-patient relationship. Conclusions There are contradictions between views of patients and doctors on benefits and risks of using social media in disease self-management. Doctors underestimate the role of social media in chronic diseases self-management and doubt in ability of patients to critically evaluate information. Key messages • Understanding differences in viewpoints can help improve doctor-patient relationships in an eHealth environment. • Resalts promotes patient empowerment. Research was supported by RSF (project No 22-18-00261).

Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era

BackgroundChronic pain is a highly prevalent and disabling condition which is often undertreated and poorly managed in the community. The emergence of COVID-19 has further complicated pain care, with an increased prevalence of chronic pain and mental health comorbidities, and burnout among physicians. While the pandemic has led to a dramatic increase in virtual health care visits, the uptake of a broader range of eHealth technologies remains unclear. The present study sought to better understand physicians’ current needs and barriers in providing effective pain care within the context of COVID-19, as well as gauge current use, interest, and ongoing barriers to eHealth implementation.MethodsA total of 100 practicing physicians in British Columbia, Canada, completed a brief online survey.ResultsThe sample was comprised of physicians practicing in rural and urban areas (rural = 48%, urban = 42%; both = 10%), with the majority (72%) working in family practice. The most prominent perceived barriers to providing chronic pain care were a lack of interdisciplinary treatment and allied health care for patients, challenges related to opioid prescribing and management, and a lack of time to manage the complexities of chronic pain. Moreover, despite expressing considerable interest in eHealth for chronic pain management (82%), low adoption rates were observed for several technologies. Specifically, only a small percentage of the sample reported using eHealth for the collection of intake data (21%), patient-reported outcomes (14%), and remote patient monitoring (26%). The most common perceived barriers to implementation were cost, complexity, and unfamiliarity with available options.ConclusionsFindings provide insight into physicians’ ongoing needs and barriers in providing effective pain management during the COVID-19 pandemic. Despite the potential for eHealth technologies to help address barriers in pain care, and strong interest from physicians, enhanced useability, education and training, and funding are likely required to achieve successful implementation of a broader range of eHealth technologies in the future.

Patient and physician perspectives on biological treatment in severe asthma: a Severe Asthma Network Italy survey.

Patients with severe asthma perceive beneficial effects of biologics and good self-reported adherence to treatment, even when self-administered at home https://bit.ly/48vP70w.

The Certificate of Added Competence credentialling program in family medicine: a descriptive survey of the family physician perspective of enhanced skill practices in Canada.

The College of Family Physicians of Canada (CFPC) offers the Certificate of Added Competence (CAC) program to designate a family physician with enhanced skills. In 2015, the College expanded its program to introduce enhanced certification in four new domains: Palliative Care, Care of the Elderly, Sports and Exercise Medicine, and Family Practice Anesthesia. In this study, we elicited perceptions from Canadian family physicians with and without the CAC on practice impacts associated with the program. Active family physicians in Canada with and without CACs were surveyed between November 2019 to January 2020. Descriptive statistics were generated to describe the perceptions of family physicians regarding the CAC program and its impacts on practice. Respondents agreed with several benefits of the program including enhancing the capacity to deliver comprehensive care, alleviating the burden of patient travel by increasing the availability of care in rural and remote communities, and providing opportunities to engage in various collaborative care models and new leadership roles. All respondents perceived CAC holders to pursue the certificate to meet both professional interests and community needs. There is a need for strong and continued investment in systemic practice improvements that incentivize the delivery of comprehensive family medicine practice.

The Comprehensive Complication Index versus Clavien-Dindo grading after laparoscopic and open D2-gastrectomy in the multicenter randomized LOGICA-trial

BackgroundComplications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional value of CCI to CDC in examining the impact of complications after gastric cancer surgery. MethodsThe CCI and CDC were determined in the multicenter randomized LOGICA-trial comparing laparoscopic versus open D2-gastrectomy for cancer (cT1-4aN0-3M0). Differences in median CCI between laparoscopic and open gastrectomy were compared for overall postoperative complications and cardiovascular, gastrointestinal, infectious, pulmonary, and other complications. CCI and CDC were correlated to hospitalization, ICU-stay and reoperations using Spearman's rho-test and compared with standard Fisher's z-transformation. ResultsBetween 2015 and 2018, 211 patients underwent laparoscopic (n = 106) or open (n = 105) D2-gastrectomy, and 157 (74%) received neoadjuvant chemotherapy. Median CCI was comparable between laparoscopic versus open gastrectomy regarding overall complications (CCI 0 [IQR 0–23.5] versus 0 [IQR 0–22.6]; p = 0.755) and subgroups of complications (p > 0.05). Both CCI and CDC showed moderate positive correlations for hospitalization (rs = 0.646 versus rs = 0.628; p = 0.001, difference clinically irrelevant), and reoperations (rs = 0.590 versus rs = 0.599; p = 0.070), and weak correlations for ICU-stay (rs = 0.446 versus rs = 0.440; p = 0.189). ConclusionsThe CCI is a composite scoring system based on the CDC and reflects a subjective interpretation of complication burden from the perspectives of both physicians and patients, following abdominal surgery other than gastrectomy. Implementing CCI showed no clinically relevant benefit and caused additional workload compared to CDC for assessing complication burden. Therefore, using the CCI alongside the CDC after gastric cancer surgery is not recommended.

160P Real-world practices and physician perspectives on biomarker testing and treatment patterns in patients with locally advanced unresectable or metastatic (La/m) gastric/gastroesophageal junction (G/GEJ) adenocarcinoma in the US

160P Real-world practices and physician perspectives on biomarker testing and treatment patterns in patients with locally advanced unresectable or metastatic (La/m) gastric/gastroesophageal junction (G/GEJ) adenocarcinoma in the US

On staying: Non-migration among Puerto Rican physicians

Since 2000, an exodus of Puerto Ricans leaving the island has reduced the local population by almost 20 per cent. One of the migratory waves of greatest concern is that of physicians due to its potential impact on Puerto Rico’s (PR) public health. Strategies to curtail their migration have overlooked the island’s unique cultural and geographic strengths that could encourage physicians to stay. This article, influenced by place attachment theory, explores the perspectives of physicians who have chosen to stay in PR. The presented data stems from qualitative interviews with 24 physicians. The findings underscore how place attachment, including an appreciation for PR’s geography and culture, influences their decision to stay. We discuss how it is crucial to integrate place attachment into any comprehensive strategy to retain physicians on the island, as it becomes an intrinsic part of their identities and lifestyles. Thus, emphasis should be placed on the environmental and social benefits of remaining in PR, not solely economic factors.

24EMF Emergency Physician Perspectives on Workplace Well-Being and Digital Mental Health

24EMF Emergency Physician Perspectives on Workplace Well-Being and Digital Mental Health

Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis: The Patient and Physician Perspective.

Diagnosing and managing metabolic dysfunction-associated steatotic liver disease (MASLD) remains a major challenge in primary care due to lack of agreement on diagnostic tools, difficulty in identifying symptoms and determining their cause, absence of approved pharmacological treatments, and limited awareness of the disease. However, prompt diagnosis and management are critical to preventing MASLD from progressing to more severe forms of liver disease. This highlights the need to raise awareness and improve understanding of MASLD among both patients and physicians. The patient perspective is invaluable to advancing our knowledge of this disease and how to manage it, as their perspectives have led to the growing recognition that patients experience subtle symptoms and that patient-reported outcomes should be incorporated into drug development. This review and expert opinion examine MASLD and metabolic dysfunction-associated steatohepatitis from the patient and physician perspective from pre-diagnosis to diagnosis and early care, through to progression to advanced liver damage. Specifically, the paper dives into the issues patients and physicians experience, and, in turn, what is required to improve diagnosis and management, including tips and tools to empower patients and physicians dealing with MASLD.

Patient and physician perspectives and experiences of basal insulin titration in type 2 diabetes in the United States: Cross-sectional surveys.

Patient- and physician-associated barriers impact the effectiveness of basal insulin (BI) titration in the management of type 2 diabetes (T2D). We evaluated the experiences of patients with T2D and physicians with BI titration education. In this observational, cross-sectional study, patients with T2D and physicians treating patients with T2D were identified by claims in the Optum Research Database and were invited to complete a survey. Eligible patients had 12 months of continuous health-plan enrolment with medical and pharmacy benefits during the baseline period, and recent initiation of BI therapy. Eligible physicians had initiated BI for ≥1 eligible patient with T2D during the past 6 months. In total, 416 patients and 386 physicians completed the survey. Ninety per cent of physicians reported treating ≥50 patients with T2D; 66% treated ≥25% of patients with BI. Whereas 74% of patients reported that BI titration was explained to them by a physician, 96% of physicians reported doing so. Furthermore, 20% of patients stated they were offered educational materials whereas 56% of physicians reported having provided materials. Physicians had higher expectations of glycaemic target achievement than were seen in the patient survey; their main concern was the patients' ability to titrate accurately (79%). There is a marked difference in patients' and physicians' experiences of BI titration education. Novel tools and strategies are required to enable effective BI titration, with more educational resources at the outset, and ongoing access to tools that provide clear, simple direction for self-titration with less reliance on physicians/health care providers.

Status of continuing education from the perspective of physicians in training

Zusammenfassung Fragestellung Die umfassende Weiterbildung des gefäßchirurgischen Nachwuchses bleibt auch im Jahr 2023 ein relevantes Thema für angehende Gefäßchirurg*innen und Weiterbildende. Dabei bewegt sich die Weiterbildung der modernen Gefäßchirurg*in im Spannungsfeld zwischen praktischer, theoretischer und akademischer Ausbildung. Hier stellt sich die Frage, inwieweit die verschiedenen Anforderungen der Weiterbildung im klinischen Alltag der Assistenzärzt*innen abgedeckt und strukturierte Lehrcurricula überhaupt vorhanden und umgesetzt werden. Material und Methoden Um den aktuellen Weiterbildungsstatus der Assistenzärzt*innen in Deutschland zu eruieren, führte das Junge Forum der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG) vom 22. Mai 2023 bis zum 9. Juni 2023 eine Umfrage unter allen ihren Mitgliedern in Weiterbildung durch. Die Umfrage umfasste dabei verschiedene Aspekte der Weiterbildung von der Lehre praktischer Fertigkeiten bis zu strukturellen Aspekten. Ergebnisse Insgesamt nahmen 81 Mitglieder der DGG teil. Das Durchschnittsalter lag bei 35 Jahren, der Frauenanteil bei 38,3 %. 48 % der Befragten arbeiteten in Krankenhäusern der Maximalversorgung. Insgesamt waren 39,5 % mit ihrer Weiterbildung zufrieden oder sehr zufrieden, während 30,7 % nur mäßig zufrieden waren. Strukturierte Weiterbildungskonzepte existierten in 53 % der Kliniken. 55 % der Teilnehmenden würden ihre Weiterbildungseinrichtung weiterempfehlen. Schlussfolgerung Die Umfrage zeigt ein deutliches Verbesserungspotenzial bei der Umsetzung der gefäßchirurgischen Weiterbildung in fast allen Bereichen. Zudem gibt es ein großes Bedürfnis nach alternativen Arbeitszeitkonzepten, um Freiräume für akademisches Arbeiten und Privatleben zu schaffen. Diese Aspekte gilt es in Zukunft zu adressieren, um eine größere Zufriedenheit und Qualität der gefäßchirurgischen Weiterbildung herzustellen.

Healthcare Interpreting in Emergency Departments: Importance of Healthcare Interpreters in the Communicational Process of Foreign Patients and Physicians

This study aims to investigate the role of healthcare interpreters in overcoming language barriers in Emergency Departments from the perspective of emergency physicians in Türkiye. Although there is a limited number of studies focusing on healthcare interpreting in EDs, they do not evaluate the opinions of ED physicians. Therefore, this study will be a pioneer research analyzing the importance of healthcare interpreting from the perspective of ED physicians in Türkiye. For this purpose, a questionnaire comprising 14 questions was prepared through the survey method to collect the opinions of emergency physicians about communication problems with foreign patients. The convenience sampling method was used to determine the study group consisting of 102 emergency physicians. The data was analyzed with descriptive analysis techniques by calculating the arithmetic mean and frequencies. After the data analysis process, it was found that communication problems in EDs lead to prolonged duration of taking anamnesis, delays in diagnosis, treatment, and discharge, extensive medical examinations, and unnecessary use of medical resources.

Working in fours: generational communication in the emergency department

BackgroundThis study examined the conflicts between different generations working in US emergency departments (ED). We sought to record generational differences involving communication preferences, perceived areas of conflict, work motivations, and attitudes regarding work-life balance.MethodsWe developed a survey to assess the physician perspective on generational conflict in the ED. The survey was distributed to members of the American College of Emergency Physicians, a professional organization comprising emergency medicine physicians in the USA.ResultsWe received 696 completed responses. Men represented 60% of respondents and the largest proportion of respondents were emergency physicians working in community settings (53%); 11% were residents. Generation representation was smallest for Traditionalist (2%) and largest for Gen X (43%). Seventy percent reported observing conflict due to generational communication with the largest frequency being once a week (26%). In the associated open-ended questions, 247 (33%) provided 316 anecdotal descriptions of observed conflict. Responses clustered into seven themes (ordered by frequency): Work Ethic, Treatment Approach, Technology Application, Entitlement, Professionalism, Work Life/Balance, and Communication Style. Comparing Work Ethic responses, 52–70-year-olds reported that younger providers are less interested in “accomplishing anything” while 26–34-year-olds resented that attitude. Respondents completing the open-ended questions regarding preventing and responding to conflict provided some insight into helpful strategies including actions supportive of clear communication and standardized policies and expectations. Only 5% of respondents reported that they had discussed generational communication in department meetings with the odds of a woman reporting conflict being less than males (p = .01).ConclusionConflicts in the ED in the USA can be attributed to how an individual views the values of someone from another generation. Understanding the frequency and areas of generational conflict in the ED can help medical leaders find strategies to mitigate negative workplace interactions.

One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases.

Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.

Physician Perspectives on Building Trust with Patients.

Prior research has documented how important it is to patients to be able to trust their physicians. In this essay, we introduce physician perspectives on the importance of earning patients' trust. We conducted twelve semistructured interviews in late 2022, eleven with physicians and one with a patient-experience expert. Physicians described earning patients' trust as crucial for working effectively with patients, with several saying that it was as important as having medical knowledge. Physicians also expressed that feeling a patient trusting them is professionally rewarding and fulfilling. To build trust with patients, physicians reported, they make the medical interaction all about the patient, express their belief in their patients, share their personal experiences, and use other strategies identified in previous literature: communicating effectively, being compassionate, and demonstrating competence. Physicians also reported experiencing challenges in building trust with patients, most often because of patients' lack of trust in other levels of the health care system and because of having inadequate time to spend with patients. Additionally, Black and Brown physicians described how patients' bias often blocks trust.