Public Trust and Initiatives for New Health Care Partnerships DAVID MECHANIC Rutgers University E ffective communication allows the physician to understand the patient’s expectations and concerns; to obtain accurate information, thereby facilitating diagnosis; to plan and manage the course of treatment; and to gain the patient’s understanding, cooperation, and adherence to treatment. Despite uni- versal recognition of the importance of communication, the demands of medical education and practice typically result in physicians’ paying less attention to their communication skills than to what are commonly viewed as more pressing medical and economic concerns. Rapid changes in health care organization and medical practice also diminish effective communication, which is essential to the cultivation of patients’ trust in their doctors and their health institutions. Many medical institutions and practitioners now are seeking new ways to engage patients in their own care and to command their trust and loyalty. In this article I will examine the social forces that are changing medical relations and will describe recent institutional initiatives for developing new health part- nerships of patients and providers. The Milbank Quarterly, Vol. 76, No. 2, 1998 © 1998 Milbank Memorial Fund. Published by Blackwell Publishers, 350 Main Street, Malden, MA 02148, USA, and 108 Cowley Road, Oxford OX4 1JF, UK. 281