Continuity and Trust in Primary Care: A Qualitative Study Informed by Game Theory

The Article in Brief

Continuity and Trust in Primary Care: A Qualitative Study Informed by Game Theory

Mary Dixon-Woods , and colleagues

Background The relationship between continuity of care and patient trust in primary care is not fully understood. This study uses game theory, developed by mathematicians in the 1920s to specify how players will act and what outcomes will result in particular games, as a lens to understand more about patients� trust in general practitioners.

What This Study Found Interviews with 20 patients in the United Kingdom suggest that game theory provides a theoretical basis for understanding the relationship between continuity of care and the development of patient trust. Patients are often willing to draw on institutional trust, derived from expectations of medicine as an institution and doctors as professionals, to engage with unfamiliar doctors. This trust provides a starting point and can be reinforced or undermined by cues to trustworthiness picked up from interpersonal aspects of the patient-physician encounter. Consistent with game theory, repeated positive interactions with the same doctor, however, can allow patients to develop more secure expectations based on a history of other interactions and anticipation of future interactions. This provides a context that makes it possible for trust to build and become secure.

Implications

• Patients do not see doctors as interchangeable, and the move toward organizing services around single encounters between patients and often unfamiliar physicians may disrupt the development of secure trust. According to the authors, this is important because trust, which, apart from its intrinsic value, is associated with health outcomes such as patient satisfaction, adherence to treatment, and perceived effectiveness of care.