Factors affecting patients' trust and confidence in GPs: evidence from the English national GP patient survey.

OBJECTIVES: Patients' trust in general practitioners (GPs) is fundamental to effective clinical encounters. Associations between patients' trust and their perceptions of communication within the consultation have been identified, but the influence of patients' demographic characteristics on these associations is unknown. We aimed to investigate the relative contribution of the patient's age, gender and ethnicity in any association between patients' ratings of interpersonal aspects of the consultation and their confidence and trust in the doctor. DESIGN: Secondary analysis of English national GP patient survey data (2009). SETTING: Primary Care, England, UK. PARTICIPANTS: Data from year 3 of the GP patient survey: 5 660 217 questionnaires sent to patients aged 18 and over, registered with a GP in England for at least 6 months; overall response rate was 42% after adjustment for sampling design. OUTCOME MEASURES: We used binary logistic regression analysis to investigate patients' reported confidence and trust in the GP, analysing ratings of 7 interpersonal aspects of the consultation, controlling for patients' sociodemographic characteristics. Further modelling examined moderating effects of age, gender and ethnicity on the relative importance of these 7 predictors. RESULTS: Among 1.5 million respondents (adjusted response rate 42%), the sense of 'being taken seriously' had the strongest association with confidence and trust. The relative importance of the 7 interpersonal aspects of care was similar for men and women. Non-white patients accorded higher priority to being given enough time than did white patients. Involvement in decisions regarding their care was more strongly associated with reports of confidence and trust for older patients than for younger patients. CONCLUSIONS: Associations between patients' ratings of interpersonal aspects of care and their confidence and trust in their GP are influenced by patients' demographic characteristics. Taking account of these findings could inform patient-centred service design and delivery and potentially enhance patients' confidence and trust in their doctor

Demons and Gods on Display : The Anthropology of Display and Worldmaking

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Animal Release and the Sacrificial Ethos in Inner Asia

Animal release is often understood as the practice of freeing an animal from human consumption or the burden of labour. Typically associated with various Buddhist or Daoist cosmologies in which liberating an animal is a merit-making act, animal release tends to be conceptualised in altruistic terms. Yet the diverse forms that sacrifice and animal release take across Inner Asia suggest that the focus of analysis sometimes shifts from a concern with freeing animals to protecting the human imperative to live. Introducing new ethnography on the ethical underpinnings of sacrifice among Buryats in northeast Mongolia and the Nuosu of southwest China, I propose that animal release can be an act of restrained violence that evokes the mythopoetic contours of human-animal relations, animal sentience and human self-preservation. Offering case studies on scapegoats, deferred sacrifice, and contingent forms of slaughter, I show how Buryats and Nuosu manage the ethical tensions posed by sacrifice.</p

The Time of Red Snowfall : Steering Social and Cosmic Renewal in Southwest China

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