How to restore trust in the American health care system

Ramin Davidoff: ©Permanente Medical Group

As a physician, I understand deeply that doctors are trusted advisors who serve in a unique role at pivotal moments in our patients’ lives.

As a urologist, I often had challenging conversations with my patients about prostate cancer and the importance of understanding their treatment options so they can be empowered to choose what’s right for them. Trust was at the heart of these discussions. When patients trust their physician, they’re more likely to communicate openly and adhere to medical advice, ultimately leading to better care outcomes. These experiences aren't just clinical encounters; they're the wellspring that continuously shape the care I provide and the leadership I offer.

However, expertise alone no longer guarantees trust. A 2025 Gallup survey shows public trust in physicians has dropped 14% since 2021, the sharpest decline of any profession. And according to the 2025 Edelman Trust Barometer, nearly 66% of respondents said that anyone with personal experience with health issues and helpful prior advice can qualify them as a health expert. Younger people especially seek health advice from peers, family members, social media platforms, and other online communities.

Building trust in an age of grievance

The Edelman report cites the current “crisis of grievance” as a key driver of mistrust. This crisis refers to a widespread sense of dissatisfaction and resentment among the public toward institutions that aren’t serving their interests, including government, business, and health care. Left unaddressed, this resentment builds over time, eroding trust and, in the case of health care, leading to less engagement with care, greater skepticism of evidence-based medical guidance, and poor health outcomes.

In the United States, this dissatisfaction is exacerbated by a fragmented health care system and concerns about transparency, access, affordability, and patient safety. A recent ECRI report says that patients often feel ignored or dismissed by doctors, fueling the crisis even more.

Why shifting to value-based care can help

Rebuilding trust occurs when health care systems create space for patients to voice their concerns, build environments that support physicians in their calling, and treat transparency as a non-negotiable.

One way to achieve this is by shifting to value-based care models that incentivize care quality and patient outcomes. More than a financial model, value-based care drives physicians and care teams to prioritize patient well-being, focusing on preventive care, patient satisfaction, and equitable health experiences; in other words, the kind of care that builds trust.

Key elements for successful value-based care include:

• Care collaboration and coordination
• Investments to facilitate access to information and care
• Candid conversations about treatment options and costs
• Addressing patient safety concerns

Care collaboration and coordination

Care collaboration and coordination are central to value-based care, which promotes teamwork among health professionals to develop comprehensive, patient-centered care plans that prevent illness and manage chronic conditions.

For example, during an eye exam, an ophthalmologist in an integrated, value-based care system may notice in the patient’s medical record that the patient is overdue for a mammogram and help to schedule one on the spot.

Innovations that facilitate engagement

The key to building trust is understanding patients in the full context of their lives. Innovations like virtual visits, remote monitoring, video visits, and mailed at-home colorectal cancer screening tests are helping us meet patients where they are with care options that are timely, convenient, and accessible. These tools empower patients to engage in their health on their own terms, which strengthens trust and promotes proactive, preventive care.

Meanwhile, recent artificial intelligence-powered technologies like ambient listening are reducing administrative burden and allowing physicians to be fully present in the exam room — improving communication, transparency, and patient understanding of their care plans. Together, these innovations are doing more than improving convenience; they’re transforming how we build meaningful, trusting relationships with patients.

Candid conversations about treatment options and costs

Patient-centered care involves physicians treating patients as partners across their entire health care journey.

Knowing their care options helps patients plan, seek alternatives, and pursue financial assistance if needed. Physicians who engage in conversations with patients about their options and benefits add value to the care experience. In fact, studies show that patients who discussed cost concerns with their doctor or care team feel they have more trust with their health care providers.

Consider the example of same-day bilateral cataract surgery, which, when safe and appropriate for patients, offers faster recovery, fewer appointments, fewer instances of anesthesia, and reduced copays, among other benefits. We’ve found cataract patients often prefer this option. However, in a fee-for-service world most cataract surgeries are still done sequentially over a span of several weeks.

Patient-centered care also appeals to younger patients who want to actively curate their own health experience rather than passively receive information. They prefer a horizontal rather than hierarchal approach to health care communication. Meeting these demands by emphasizing transparency, empathy, respect, communication, and collaboration also helps build trust.

Addressing patient safety concerns

The 2025 Edelman Trust Barometer reveals that misinformation is a growing threat to patient safety, with younger people regretting health choices made on bad information. At the same time, ECRI’s 2025 list named dismissing patient concerns as a top risk to patient safety. Both show that truth, safety, and listening are inseparable in health care.

Online health information — from social media to unvetted videos — often spreads unproven “cures” for serious conditions like cancer, leading some people to delay or abandon effective treatments. Evidence-based, value-based care counters this by prioritizing direct, trusted communication between patients and providers, paired with personalized education. This approach reduces the risk of medical gaslighting, where genuine concerns are dismissed without proper evaluation, and ensures patients feel heard and supported.

Trust’s vital role in value-based care

In value-based care, three crucial goals define what truly matters: enhancing quality, reducing costs, and improving the patient experience. As physicians, we achieve these goals by focusing on outcomes, meticulously coordinating care, investing in a positive patient experience, improving health literacy, and actively listening. By integrating these elements into our medical practice, we can build trust with each patient.

Ramin Davidoff, MD, is executive medical director and board chair of the Southern California Permanente Medical Group, board chair and CEO of The Southeast Permanente Medical Group; board chair and CEO of The Hawaii Permanente Medical Group; and co-CEO of The Permanente Federation.