The Trust in Doctors’ Dilemma: Investigating the Role of Patients’ Perceived Communication

Trust in physicians and effective communication are central to high-quality healthcare, yet public confidence continues to decline amid concerns about unethical practices and communication breakdowns. Despite extensive scholarship in healthcare ethics, limited attention has been given to how patients subjectively perceive and assess ethical behavior through their lived experiences. This qualitative study examines how perceived communication shapes patient trust and evaluations of physicians’ ethical conduct within the Tunisian healthcare context, focusing on the relational mechanisms that inform ethical judgments. An inductive thematic analysis was conducted using semi-structured interviews with 23 adult patients (12 men, 11 women; aged 19–68 years) recruited from several hospitals between April and June 2025. Interviews lasted 40–80 minutes, were audio-recorded, transcribed verbatim, and analyzed. Three major themes emerged: (1) general healthcare experiences, highlighting marked contrasts between private services, whereas perceived as professional yet financially burdensome, and public services, characterized by overcrowding, limited resources, and staff negligence; (2) trust in doctors, comprising four components, such as empathy, knowledge, dependability, and reputation, that collectively shape trust formation; and (3) doctor–patient communication, encompassing seven subthemes including respect, transparency, humanizing rapport, simplification of information, honesty, communicative style, and comforting behavior. Participants emphasized that trust is not solely grounded in clinical competence but is deeply rooted in emotional connection, moral character, and the quality of interpersonal communication. Perceived communication thus functions as a decisive influence on trust in doctors. The findings suggest the imperative for healthcare institutions to enhance communication training and relational competencies alongside technical expertise, while underscoring the value of integrating communicative dimensions into ethical frameworks and quality-of-care assessments.

Patient trust, doctor-patient communication, healthcare ethics, thematic analysis, Tunisia

1. Alanazi, M. A., Shaban, M. M., Ramadan, O. M. E., Zaky, M. E., Mohammed, H. H., Amer, F. G. M., & Shaban, M. (2024). Navigating end-of-life decision-making in nursing: A systematic review of ethical challenges and palliative care practices. BMC Nursing, 23(467). https://doi.org/10.1186/s12912-024-02087-5 [Google Scholar] [Crossref]

2. Bai, H., Li, F., & He, Z. (2025). Bridging the trust gap: The mediating role of patient satisfaction in physician empathy. Frontiers in Medicine, 12, Article 1647105. [Google Scholar] [Crossref]

3. https://doi.org/10.3389/fmed.2025.1647105 [Google Scholar] [Crossref]

4. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa [Google Scholar] [Crossref]

5. Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806 [Google Scholar] [Crossref]

6. Çakmak, C., & Uğurluoğlu, Ö. (2024). The effects of patient-centered communication on patient engagement, health-related quality of life, service quality perception and patient satisfaction in patients with cancer. Cancer Control, 31, Article 10732748241236327. [Google Scholar] [Crossref]

7. https://doi.org/10.1177/10732748241236327 [Google Scholar] [Crossref]

8. Consolandi, M. (2024). Science communication and health: Fostering trust in doctor-patient interaction. Emerald Publishing Limited. https://doi.org/10.1108/978-1-80441-893-220241001 [Google Scholar] [Crossref]

9. Doubova, S. V., Guanais, F. C., Pérez-Cuevas, R., Mayer, S., Wirtz, V. J., & Reich, M. R. (2016). Attributes of patient-centered primary care associated with the public perception of good healthcare quality in Brazil, Colombia, Mexico and El Salvador. Health Policy and Planning, 31(7), 834–843. https://doi.org/10.1093/heapol/czv139 [Google Scholar] [Crossref]

10. Dugan, E., Trachtenberg, F., & Hall, M. A. (2005). Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Services Research, 5(1), Article 64. https://doi.org/10.1186/1472-6963-5-64 [Google Scholar] [Crossref]

11. Efthymiou, I. P. (2024). The importance of soft skills in healthcare: The impact of communication, empathy, and teamwork on doctor-nurse interactions. International Case Studies Journal, 13(6), 1–12. [Google Scholar] [Crossref]

12. Epstein, R. M., & Street, R. L. (2007). Patient-centered communication in cancer care: Promoting healing and reducing suffering [NIH Publication No. 07-6225]. National Cancer Institute. https://doi.org/10.1037/e481972008-001 [Google Scholar] [Crossref]

13. Ewunetu, M., Temesgen, W., Zewdu, D., & Getachew, B. (2023). Patients’ perception of patient-centered care and associated factors among patients admitted in private and public hospitals: A comparative cross-sectional study. Patient Preference and Adherence, 17, 615–626. https://doi.org/10.2147/PPA.S402262 [Google Scholar] [Crossref]

14. Fleisje, A. (2024). Four shades of paternalism in doctor–patient communication and their ethical implications. Bioethics, 38(5), 445–454. https://doi.org/10.1111/bioe.13307 [Google Scholar] [Crossref]

15. Gopichandran, V., & Sakthivel, K. (2021). Doctor-patient communication and trust in doctors during COVID 19 times—A cross sectional study in Chennai, India. PLoS ONE, 16(6), Article e0253497. https://doi.org/10.1371/journal.pone.0253497 [Google Scholar] [Crossref]

16. Gu, L., Tian, B., Xin, Y., Zhang, S., Li, J., & Sun, Z. (2022). Patient perception of doctor communication skills and patient trust in rural primary health care: The mediating role of health service quality. BMC Primary Care, 23(1), Article 182. https://doi.org/10.1186/s12875-022-01826-4 [Google Scholar] [Crossref]

17. Hall, M. A., Camacho, F., Dugan, E., & Balkrishnan, R. (2002). Trust in the medical profession: Conceptual and measurement issues. Health Services Research, 37(5), 1419–1439. https://doi.org/10.1111/1475-6773.01070 [Google Scholar] [Crossref]

18. Hall, M. A., Dugan, E., Zheng, B., & Mishra, A. K. (2001). Trust in physicians and medical institutions: What is it, can it be measured, and does it matter? The Milbank Quarterly, 79(4), 613–639. https://doi.org/10.1111/1468-0009.00223 [Google Scholar] [Crossref]

19. Hall, M. A., Zheng, B., Dugan, E., Camacho, F., Kidd, K. E., Mishra, A., & Balkrishnan, R. (2002). Measuring patients’ trust in their primary care providers. Medical Care Research and Review, 59(3), 293–318. https://doi.org/10.1177/1077558702059003004 [Google Scholar] [Crossref]

20. Honavar, S. G. (2018). Patient–physician relationship—Communication is the key. Indian Journal of Ophthalmology, 66(11), 1527–1528. https://doi.org/10.4103/ijo.IJO_1760_18 [Google Scholar] [Crossref]

21. Huang, E. C. H., Pu, C., Chou, Y. J., & Huang, N. (2018). Public trust in physicians—Health care commodification as a possible deteriorating factor: Cross-sectional analysis of 23 countries. Inquiry: The Journal of Health Care Organization, Provision, and Financing, 55, Article 0046958018759174. https://doi.org/10.1177/0046958018759174 [Google Scholar] [Crossref]

22. Jameel, A., Sahito, N., Guo, W., & Khan, S. (2025). Assessing patient satisfaction with practitioner communication: Patient-centered care, hospital environment and patient trust in the public hospitals. Frontiers in Medicine, 12, Article 1544498. https://doi.org/10.3389/fmed.2025.1544498 [Google Scholar] [Crossref]

23. Lazarus, J. V., White, T. M., Wyka, K., Ratzan, S. C., Rabin, K., Leigh, J. P., Hu, J., Acharya, B., & El-Mohandes, A. (2024). Influence of COVID-19 on trust in routine immunization, health information sources and pandemic preparedness in 23 countries in 2023. Nature Medicine, 30(4), 1097–1105. https://doi.org/10.1038/s41591-024-02939-2 [Google Scholar] [Crossref]

24. Li, J., & Street, R. L., Jr. (2025). What encourages patients to recommend their doctor after an online medical consultation? The influence of patient-centered communication, trust, and negative health information seeking experiences. Health Communication, 40(3), 480–491. https://doi.org/10.1080/10410236.2024.2383801 [Google Scholar] [Crossref]

25. Liu, X., Zeng, J., Li, L., Wang, Q., Chen, J., & Huang, Y. (2024). The influence of doctor-patient communication on patients’ trust: The role of patient-physician consistency and perceived threat of disease. Psychology Research and Behavior Management, 17, 789–801. https://doi.org/10.2147/PRBM.S460689 [Google Scholar] [Crossref]

26. Ostrom, A. L., Parasuraman, A., Bowen, D. E., Patrício, L., & Voss, C. A. (2015). Service research priorities in a rapidly changing context. Journal of Service Research, 18(2), 127–159. https://doi.org/10.1177/1094670515576315 [Google Scholar] [Crossref]

27. Pellegrini, C. A. (2017). Trust: The keystone of the patient-physician relationship. Journal of the American College of Surgeons, 224(2), 95–102. https://doi.org/10.1016/j.jamcollsurg.2016.10.032 [Google Scholar] [Crossref]

28. Pérez-Arechaederra, D., Briones, E., & Lázaro, S. (2025). Communication and relationships: How patients perceive informational and interactional organizational justice can improve patient-centered care, a study with implications for healthcare quality. BMC Health Services Research, 25(1), Article 126. https://doi.org/10.1186/s12913-025-12461-x [Google Scholar] [Crossref]

29. Petrocchi, S., Iannello, P., Lecciso, F., Levante, A., Antonietti, A., & Schulz, P. J. (2019). Interpersonal trust in doctor-patient relation: Evidence from dyadic analysis and association with quality of dyadic communication. Social Science & Medicine, 235, Article 112391. https://doi.org/10.1016/j.socscimed.2019.112391 [Google Scholar] [Crossref]

30. Thom, D. H., Hall, M. A., & Pawlson, L. G. (2004). Measuring patients’ trust in physicians when assessing quality of care. Health Affairs, 23(4), 124–132. https://doi.org/10.1377/hlthaff.23.4.124 [Google Scholar] [Crossref]

31. Tomaselli, G., Buttigieg, S. C., Rosano, A., Cassar, M., & Grima, G. (2020). Person-centered care from a relational ethics perspective for the delivery of high quality and safe healthcare: A scoping review. Frontiers in Public Health, 8, Article 44. https://doi.org/10.3389/fpubh.2020.00044 [Google Scholar] [Crossref]

32. Udow-Phillips, M., Smyser, J., & Moniz, M. H. (2025). Rebuilding trust in public health and medicine in a time of declining trust in science. Journal of Hospital Medicine, 20(1), 81–84. https://doi.org/10.1002/jhm.70086 [Google Scholar] [Crossref]

33. Wang, X., Chen, Y., Yu, Y., Jiang, H., Song, J., & Zhao, Q. (2025). From numerical to empathy: The dual impact of psychological contracts in doctor-patient communication. Frontiers in Psychiatry, 16, Article 1530932. https://doi.org/10.3389/fpsyt.2025.1530932 [Google Scholar] [Crossref]

34. Ward, P. (2018). Trust and communication in a doctor-patient relationship: A literature review. Archives of Medicine, 10(3:6), 1–6. [Google Scholar] [Crossref]

35. Wu, Q., Jin, Z., & Wang, P. (2022). The relationship between the physician-patient relationship, physician empathy, and patient trust. Journal of General Internal Medicine, 37(6), 1388–1393. https://doi.org/10.1007/s11606-021-07008-9 [Google Scholar] [Crossref]

36. Zhang, L., Wang, B., & Fu, C. (2025). The effect of patient participation on trust in primary health care physicians among patients with chronic diseases: The mediating role of perceived value. Frontiers in Public Health, 13, Article 1586123. https://doi.org/10.3389/fpubh.2025.1586123 [Google Scholar] [Crossref]

• Assessment of the Role of Artificial Intelligence in Repositioning TVET for Economic Development in Nigeria
• Teachers’ Use of Assure Model Instructional Design on Learners’ Problem Solving Efficacy in Secondary Schools in Bungoma County, Kenya
• “E-Booksan Ang Kaalaman”: Development, Validation, and Utilization of Electronic Book in Academic Performance of Grade 9 Students in Social Studies
• Analyzing EFL University Students’ Academic Speaking Skills Through Self-Recorded Video Presentation
• Major Findings of The Study on Total Quality Management in Teachers’ Education Institutions (TEIs) In Assam – An Evaluative Study