My final patient of the day had consulted four different doctors prior to visiting me. She was seeking help for abdominal pain that had persisted for approximately two years and had engaged several specialists, leading to multiple tests in hopes of clarifying her symptoms. She arrived looking for answers, yet was also doubtful about my capabilities. Doubtful regarding my potential to assist her, my expertise, and even my concern for her well-being. She did not have faith that I possessed the tools, competence, commitment, and empathy to support her, listen to her, and provide assistance. Although she had never met me before, her prior experiences had shaped her present beliefs, or lack thereof.
Just like trust is essential for an infant’s survival, it serves as a crucial element in the provider-patient relationship. In the past, physicians were perceived as highly trustworthy figures in society, and their advice was both sought after and esteemed. Over time, this level of trust in physicians has diminished, and since the onset of the COVID-19 pandemic until just last year, the proportion of individuals who trust their healthcare providers has fallen by 30 percent. This significant decline occurs during a period when healthcare professionals (practitioners and public health authorities alike) should have been turned to for expert insights and guidance on navigating the pandemic, based on their understanding of scientific research and emerging studies.
What has caused this gradual decline over the years, and why, amid one of the largest pandemics in recorded history, did trust in scientific professionals plummet even more? Why does this trend persist daily? While it would be ideal to identify a single underlying cause that could be easily addressed to restore trust, unfortunately, this is not the reality. The erosion of trust is influenced by multiple factors, is intricate, and encompasses aspects we can identify as well as some we still do not comprehend.
The healthcare landscape has transformed significantly over time. Physicians once made home visits, treated entire families, and addressed nearly every issue a patient faced. They were viewed as extended family members and were respected as healers. They did not bear the weight of loans, the pressure to fulfill RVUs, or the concern over insurance coverage for the medications they prescribed. There was no Big Pharma, no social media backlash, no dissonance with the government. As life expectancy increases, the burden of disease escalates, and the means to prevent, manage, and treat these conditions become more intricate. Conducting thorough research is challenging enough, and the multifactorial nature of disease processes can make definitive answers elusive. Combine this with the demand for immediate explanations for a condition or its management, alongside misinformation, disinformation, and the politicization of healthcare, and you create an ideal scenario for distrust in the healthcare system.
The complex roots of distrust that many patients harbor have led to numerous individuals arriving at healthcare facilities with suspicion and departing placated at best, but more frequently feeling disappointed and unsatisfied. While addressing this issue may seem overwhelming and nearly unattainable, the truth is that we as healthcare providers must strive both individually and collectively to mend the trust. There is no margin for failure here. It is essential to consider trust as a determinant of health; without it, we are unable to deliver the care we aspire to provide, the very reason we chose to pursue a career in healthcare in the first place. In its absence, patients’ health deteriorates.
We must listen, pose questions, and uncover the journey patients undertook prior to meeting us, in order to grasp their current situation. We need to cultivate cultural curiosity and competence. We must recognize our implicit biases. We need to understand which platforms different age groups, genders, and ethnicities utilize to gather health information. We must forge connections with our patients. We should maintain eye contact while conversing. We need to demonstrate our concern, rather than assume they acknowledge it automatically. We must involve them in the decision-making process, listen to their aspirations, address their worries, and understand their constraints regarding their care plan. We need to cultivate a dialogue that ensures they feel comfortable, cared for, visible, and heard. This is within our reach as healthcare providers, and while numerous factors contributing to the current state of distrust may seem far more challenging to tackle and, frankly, beyond our control, the interactions we have with our patients can be managed and directed by our words and actions.
When I was applying to medical school, my inexperienced self was unaware that my ability to assist individuals in the future would be so profoundly influenced by forces beyond my control. Influenced by policies, institutional finances, insurance companies, burnout, patient finances, and even the neighborhood where a patient resides. My inexperienced self had no concept that a patient’s trust in what I proposed regarding their care, believing that