Continuity and trust in primary care: a qualitative study informed by game theory.

Purpose: The relationship between continuity of care and patient trust in primary care is not fully understood. We report an empirical investigation, informed by game theory, of patients' accounts of their trust in general practitioners (GPs).

Methods: We conducted an analysis based on the constant comparative method of 20 semistructured interviews with patients about trust in GPs in the United Kingdom.

Results: People use institutional trust, derived from expectations of medicine as an institution and doctors as professionals, as a starting point for their transactions with unfamiliar doctors. This expectation may be enough to allow patients the minimum of what they want from doctors and is often sufficient for single-episode encounters, where patients have specific goals. Repeated interactions with the same doctor can allow patients to develop more secure expectations, based on a history of other interactions and anticipation of future interactions. Secure trust can develop over time, especially if patients are convinced that the doctor has their interests at heart.

Conclusions: This work identifies dynamics inherent in repeated interactions that enable secure trust to develop. These findings have important implications for the design of services, which in the United Kingdom and elsewhere are increasingly focused on enhancing access rather than continuity. They suggest that patients do not see GPs as interchangeable and that the move toward organizing services around single encounters may disrupt the development of secure trust.