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Q J Med 2000; 93: 55-61
© 2000 Association of Physicians

Commentary

Situational trust and co-operative partnerships between physicians and their patients: a theoretical explanation transferable from business practice

M.R. Dibben1, S. Eley Morris2 and M.E.J. Lean3

1 From the Department of Management Studies, University of Aberdeen, Aberdeen, and 2 Department of Applied Social Science, University of Stirling, Stirling, and 3 Department of Human Nutrition, University of Glasgow, Glasgow, UK

Dr M.R. Dibben, Visiting Research Fellow, University Department of Human Nutrition, Glasgow Royal Infirmary, Glasgow G3 2ER

A model to explain interpersonal trust development, and its consequences for co-operative behaviour in doctor/patient partnerships derived from the context of business relationships is applied to patient/physician relationships. Threshold barriers exist against all human behaviours or actions and trust is the process by which barriers to co-operation and compliance are overcome. Dispositional trust (a psychological trait to be trusting) is dominant in the early stages of a relationship and contributes to the weight of subsequent trust development. Co-operative behaviour or compliance ultimately requires a secure situational trust emerging from consultations, which is carried forward as learnt trust and modified in each subsequent consultation. The model comprises three types of situational trust (calculus-based, knowledge-based, and identification trust) and five co-operation criteria from which to determine an individual's tendency for co- operative behaviour. These model components can be identified and mapped from a range of qualitative data, with the aim of enhancing co-operative behaviour and efficiently achieving optimal patient compliance.


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