Response: Re: Doctor-Patient Trust Among Chronic Pain Patients on Chronic Opioid Therapy after Opioid Risk Reduction Initiatives: A Survey
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* Karen J. Sherman
* Michael Parchman
* Evette J. Ludman
* Michael Von Korff

*To the Editor:* We thank Dr. Otufowora for his interesting comments regarding our recent publication.1 First, we would like to point out that our article describes patients' trust in their physician in relation to managing opioid pain medications. It is not about their overall trust in their physician. As we noted in our article,2 management of chronic opioid therapy can be contentious and thus, it is possible that trust in this component of care could differ from other aspects of care. We are unaware of past research on this more specialized aspect of trust. For none of the physicians in the study did our research team have access to data on the doctor's interpersonal skills and style of communication. Nonetheless, it is hard to imagine that among the hundreds of primary care physicians who worked in the Group Health clinics, they would be systematically less skilled in interpersonal skills and communication than those community doctors who treated Group Health patients outside of those clinics, particularly when dealing with patients on chronic opioid therapy. This is especially true because our physicians were trained in the 4 habits model of clinical communication.3

In addition, Dr Otufowora wondered whether our results would be generalizable to other types of health insurance, where presumably more choice of primary care physicians is available and trust in physicians could be higher? We have no data on this point, and indeed in our discussion section, encouraged further research on assessing the impact of opioid risk reduction initiatives in more diverse populations. Nonetheless, we think our findings are internally valid. We hope others are encouraged by our findings and this correspondence to undertake rigorous research on the patients' trust of physicians related to management of chronic opioid therapy.

## Notes

*   The above letter was referred to the author of the article in question, who offers the following reply.

## References

1.  1.Otufowora A. Re: Doctor-patient trust among chronic pain patients on chronic opioid therapy after opioid risk reduction initiatives: A survey. J Am Board Fam Med 2018;31:957.
    
    [FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NToiamFiZnAiO3M6NToicmVzaWQiO3M6ODoiMzEvNi85NTciO3M6NDoiYXRvbSI7czoyMjoiL2phYmZwLzMxLzYvOTU3LjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2.Sherman KJ, Walker RL, Saunders K, et al. Doctor-patient trust among chronic pain patients on chronic opioid therapy after opioid risk reduction initiatives: A Survey. J Am Board Fam Med 2018;31:578–87.
    
    [Abstract/FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiamFiZnAiO3M6NToicmVzaWQiO3M6ODoiMzEvNC81NzgiO3M6NDoiYXRvbSI7czoyMjoiL2phYmZwLzMxLzYvOTU3LjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  3.Frankel RM, Stein T. Getting the Most Out of the Clinical Encounter: The Four Habits Model. J Med Pract Manage 2001;16:184–91.
    
    [PubMed](http://www.jabfm.org/lookup/external-ref?access_num=11317576&link_type=MED&atom=%2Fjabfp%2F31%2F6%2F957.2.atom)