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

Abstract

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.