To the Editor: I commend Dr. Karen Sherman and colleagues1 on their work on trust and the doctor-patient relationship in patients on chronic opioid therapy. There are, however, 2 issues that I would like addressed.
First, according to this article, when discussing the study population, “the remaining members received care from community doctors, about whom little information is available”; this point was not acknowledged as a limitation of the study. This is vital because the strongest predictors of trust in a doctor-patient relationship are the doctor's personality and behavior and patients' trust has been shown to be affected by doctors' interpersonal skills and style of communications.2⇓–4 Could factors other than the opioid reduction initiatives have contributed to the differential trust level between the 2 groups?
Second, studies have shown that the type of health insurance affects patients' trust. Insurance plans with more choice of physician engender more trust.3,5,6 Given that all study participants were from Group Health Cooperative, a monolithic group, and there was no information given on the plan types, the generalizability of the results to the general population on chronic opioid therapy is not known.
Notes
The author has no conflicts of interest. The author is a Graduate school Dean's Scholar at the College of Public Health and Health Professions, University of Florida; and thankful to his research mentor, Dr. Linda Cottler, for her support.
The above letter was referred to the author of the article in question, who offers the following reply.
