Top challenges of 2022, No. 5: Loss of trust in physicians

Medical Economics Journal, Medical Economics January 2022, Volume 99, Issue 1

Editor's Note: The past year has been one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, Medical Economics® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). We decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring. Here's number five.

Doctors often complain that, like the late comedian Rodney Dangerfield, they “don’t get no respect.” But when it comes to respect and trust, medicine and its practitioners fare better than many other aspects of American society.

In a 2019 Pew Research Center survey, 74% of respondents said they had a “mostly positive” view of medical doctors. By contrast, only 35% said they had a “great deal” or “fair amount” of confidence that elected officials will act in the public’s best interest, and 46% said the same of business leaders.

Still, trust in physicians has been declining. In a 2017 Sermo survey, 87% of doctors said patients trust them less than they did a decade earlier.

The trend is especially pronounced among younger Americans. A November 2021 Morning Consult survey found that 74% of baby boomers trust the health care system “some” or “a lot,” but that number drops to 44% among members of Generation Z — those born between the late 1990s and early 2010s.

What has caused this erosion of trust in doctors, and medicine generally? In part, experts say, it reflects Americans’ ongoing loss of faith in all institutions that began with the Vietnam War and Watergate. But there are also reasons specific to medicine. Probably the biggest of these is the limited time primary care doctors working for large hospital systems — now the majority — can spend with patients.

Bioethicist Stephen Post, Ph.D., told Medical Economics® in 2018 that many hospital systems, where the majority of primary care physicians now practice, require doctors to see an average of eight patients in 30 minutes. “Given that pace, it’s extremely difficult to build trust and create meaningful relationships,” Post said. Compounding the problem, patients often do not stay with the same doctor long enough to establish trust; doctors leave (or are dropped from) insurance networks, or employers change insurance carriers in search of lower costs.

Another contributor to eroding trust is the ready availability of medical and wellness information, as well as information and ratings for health care providers, on the internet and via social media. A 2015 Medical Economics® article noted that about 5% of all Google searches were health-related and the percentage has almost certainly grown since then. “We’ve seen an explosion in the kind of information that ordinary people can access about their own health and from sources like medical journals and the results of clinical trials,” author and patient engagement consultant Jan Oldenburg told Medical Economics® in 2019.

Oldenburg and other experts say that although this “patient empowerment” lets patients become more actively involved in their health and wellness, it also means they are less likely to unquestioningly trust a physician’s diagnosis or follow a treatment plan than were patients in the era before the internet.

Patients’ confidence in their care providers is further weakened by skyrocketing care costs. Although doctors are not primarily responsible for the problem, they often bear the brunt of patient anger. Eighty-seven percent of physician respondents to a 2016 Medical Economics® survey said their practices were encountering more angry patients than a year or two earlier, and 56% said financial issues were the main cause of patient anger. Among some patients, that anger takes the form of believing their doctor is recommending unnecessary tests or procedures to earn more money.

Of course, for large groups within American society — especially people of color — mistrust of doctors and the health care system is longstanding and frequently justified. A 2003 Institute of Medicine report on racial and ethnic disparities in health care found evidence that “stereotyping, biases and uncertainty on the part of health care providers can all contribute to unequal treatment.” Moreover, the report said, White clinicians who do not believe they are prejudiced “typically demonstrate unconscious implicit negative racial attitudes and stereotypes.” Many public health experts believe this distrust among members of the Black and Hispanic communities contributed to their initial reluctance to get COVID-19 vaccines as compared with White people (although the gap has since narrowed).

Establishing — or rebuilding — trust with patients is not easy, especially given the time and financial constraints most doctors face. Nevertheless, it is possible. The process starts with maximizing the time available to spend with patients by, for example, delegating to staff members tasks that reduce time for doctor-patient interactions. Then use the time to listen. “Let patients talk about the personal aspects of their illness, then add an affirming comment like ‘That must be very difficult,’” Post advises.

Dhruv Khullar, M.D., M.P.P., a New York City internist and author of a New York Times article about trust, reminds doctors that they can no longer expect trust automatically, but “if we work hard to demonstrate that we’re trustworthy, patients will come to trust us over time.”