Trust Matters for Doctors? Towards an Agenda for Research

Sociological research offers crucial understanding of the salience of trust for patients in mediating a plurality of healthcare activities and settings. Whilst insights generated surrounding the salience of trust for patients are important, other trusting relations within healthcare have largely been neglected. This paper focuses on the significance of trust for doctors, arguing that trust is salient for doctors in facilitating their professional role, in the management of complexity and uncertainty in contemporary medical practice, and is a key mechanism underpinning professional identity. As such, the paper develops a preliminary conceptual framework for researching trust by doctors built upon the idea of a ‘lattice’ of doctor trust relations in various entities and at various levels that may be interconnected. The lattice of doctor trust is comprised of four primary conceptualisations – trust in patients, self trust, workplace trust, and system trust. The paper explores notions of doctors’ need to trust patients to provide accurate information and to commit to certain treatment pathways; the relationship between the self trust of the doctor, clinical activity and trust in others; the need for doctors to trust their professional colleagues and the broader organisational setting to ensure the smooth running of services and integration of care; and notions surrounding the complexity of the broader systems of modern (bio)medicine and the role of trust by doctors to facilitate system functioning

Measuring empathy in pediatrics: validation of the Visual CARE measure

Background: Empathy is a key element of “Patient and Family Centered Care”, a clinical approach recommended by the American Academy of Pediatrics. However, there is a lack of validated tools to evaluate paediatrician empathy. This study aimed to validate the Visual CARE Measure, a patient rated questionnaire measuring physician empathy, in the setting of a Pediatric Emergency Department (ED). Methods: The empathy of physicians working in the Pediatric ED of the University Hospital of Udine, Italy, was assessed using an Italian translation of the Visual Care Measure. This test has three versions suited to different age groups: the 5Q questionnaire was administered to children aged 7–11, the 10Q version to those older than 11, and the 10Q–Parent questionnaire to parents of children younger than 7. The internal reliability, homogeneity and construct validity of the 5Q and 10Q/10Q–Parent versions of the Visual Care Measure, were separately assessed. The influence of family background on the rating of physician empathy and satisfaction with the clinical encounter was also evaluated. Results: Seven physicians and 416 children and their parents were included in the study. Internal consistency measured by Cronbach’s alpha was 0.95 for the 10Q/10Q–Parent versions and 0.88 for the 5Q version. The item-total correlation was > 0.75 for each item. An exploratory factor analysis showed that all the items load onto the first factor. Physicians’ empathy scores correlated with patients’ satisfaction for both the 10Q and 10Q–Parent questionnaires (Spearman’s rho = 0.7189; p < 0.001) and for the 5Q questionnaire (Spearman’s rho = 0.5968; p < 0,001). Trust in the consulting physician was lower among immigrant parents (OR 0.43. 95% CI 0.20–0.93). Conclusions: The Visual Care Measure is a reliable second-person test of physician empathy in the setting of a Pediatric Emergency Room. More studies are needed to evaluate the reliability of this instrument in other pediatric settings distinct from the Emergency Room and to further evaluate its utility in measuring the impact of communication and empathy training programmes for healthcare professionals working in pediatrics

Functional relationships in the nuclear and extended family: A 16-culture study

This study investigated the relationship between culture, structural aspects of the nuclear and extended family, and functional aspects of the family, that is, emotional distance, social interaction, and communication, as well as geographical proximity. The focus was on the functional aspects of family, defined as members of the nuclear family (mother, father, and their children) and the extended family (grandmother/grandfather, aunt/uncle, cousins). Sixteen cultures participated in this study, with a total number of 2587 participants. The first hypothesis, that the pattern of scores on the psychological measures and the behavioral outcomes are similar across cultures, an indication of cultural universality, was supported. The second hypothesis, that functional relations between members of the nuclear family and their kin are maintained in high-affluent and low-affluent cultures, and that differences in functional relationships in high-and low-affluent cultures are a matter of degree, was also supported by the findings. The results suggest that it is less meaningful in cross-cultural family studies to ask questions about the structure of the family, than to ask about the functional relationships between members of the nuclear family and their kin. In looking only at the nuclear family, one focuses only on those residing in the household, but ignores those important members of the extended family who may reside nearby and their significant relationships with the members of the nuclear family