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Trust in One’s Physician: The Role of Ethnic Match, Autonomy, Acculturation, and Religiosity Among Japanese and Japanese Americans

¹ Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif
² RAND Health, Santa Monica, Calif
³ School of Public Health and Asian American Studies, David Geffen School of Medicine, University of California, Los Angeles, Calif
⁴ University of Tokyo, Tokyo, Japan
⁵ National Tokyo Medical Center, Tokyo, Japan
⁶ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Calif
⁷ Kyoto University, Kyoto, Japan
⁸ UCLA Healthcare Ethics Center, David Geffen School of Medicine, University of California, Los Angeles, Calif

CORRESPONDING AUTHOR: Derjung Mimi Tarn, MD, MS, UCLA Department of Family Medicine, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024, dtarn{at}mednet.ucla.edu

PURPOSE Trust is a cornerstone of the physician-patient relationship. We investigated the relation of patient characteristics, religiosity, acculturation, physician ethnicity, and insurance-mandated physician change to levels of trust in Japanese American and Japanese patients.

METHODS A self-administered, cross-sectional questionnaire in English and Japanese (completed in the language of their choice) was given to community-based samples of 539 English-speaking Japanese Americans, 340 Japanese-speaking Japanese Americans, and 304 Japanese living in Japan.

RESULTS Eighty-seven percent of English-speaking Japanese Americans, 93% of Japanese-speaking Japanese Americans, and 58% of Japanese living in Japan responded to trust items and reported mean trust scores of 83, 80, and 68, respectively, on a scale ranging from 0 to 100. In multivariate analyses, English-speaking and Japanese-speaking Japanese American respondents reported more trust than Japanese respondents living in Japan (P values <.001). Greater religiosity (P <.001), less desire for autonomy (P <.001), and physician-patient relationships of longer duration (P <.001) were related to increased trust. Among Japanese Americans, more acculturated respondents reported more trust (P <.001), and Japanese physicians were trusted more than physicians of another ethnicity. Among respondents prompted to change physicians because of insurance coverage, the 48% who did not want to switch reported less trust in their current physician than in their former physician (mean score of 82 vs 89, P <.001).

CONCLUSIONS Religiosity, autonomy preference, and acculturation were strongly related to trust in one’s physician among the Japanese American and Japanese samples studied and may provide avenues to enhance the physician-patient relationship. The strong relationship of trust with patient-physician ethnic match and the loss of trust when patients, in retrospect, report leaving a preferred physician suggest unintended consequences to patients not able to continue with their preferred physicians.

Key Words: Trust • acculturation • personal autonomy • physician-patient relations • Asian Americans

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