OBJECTIVE:To evaluate the extent to which physician choice, length of patient-physician relationship, and perceived physician payment method predict patients' trust in their physician. DESIGN:Survey of patients of physicians in Atlanta, Georgia. PATIENTS:Subjects were 292 patients aged 18 years and older. MEASUREMENTS AND MAIN RESULTS:Scale of patients' trust in their physician was the main outcome measure. Most patients completely trusted their physicians "to put their needs above all other considerations" (69%). Patients who reported having enough choice of physician ( p Ͻ .05), a longer relationship with the physician ( p Ͻ .001), and who trusted their managed care organization ( p Ͻ .001) were more likely to trust their physician. Approximately two thirds of all respondents did not know the method by which their physician was paid. The majority of patients believed paying a physician each time a test is done rather than a fixed monthly amount would not affect their care (72.4%). However, 40.5% of all respondents believed paying a physician more for ordering fewer than the average number of tests would make their care worse. Of these patients, 53.3% would accept higher copayments to obtain necessary medical tests. T rust is a fundamental aspect of the patient-physician relationship. 1-5 Even well-informed and knowledgeable patients have to rely on their physicians to provide them with appropriate information, keep personal information confidential, provide competent care, and act in their best interests. In spite of the importance of trust to the patient-physician relationship, there are few studies of the factors related to patients' trust in their physicians. CONCLUSIONS:One predictor of trust in social relationships is the length of those relationships, 6-8 and there is reason to believe this would hold for patient-physician relationships. 9 Having a choice of physician is important to many patients, 10-13 and it is possible that wider choices would encourage greater trust in the physician eventually chosen. Recent developments in health care delivery also make it plausible that the way physicians are paid could influence patients' trust in them. Reports regularly appear in the popular press about how new managed care arrangements may compromise the care provided to patients. Health service researchers have shown that payment methods may have an impact on clinical decision making. 14-16 We know of no empirical studies that have examined whether patients' beliefs about how their physician is paid affect their trust in the physician. In the study described herein, we interviewed a probability sample of patients covered by a large health care insurer in Atlanta. We assessed how patients thought their physicians were paid and whether their perceptions were accurate. We also examined whether availability of a choice of physicians, length of patient-physician relationship, or perceived physician payment method was related to the patients' trust in their physician. METHODS Study Design and SampleThe study was con...

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