The Erosion of Trust in Healthcare
For several decades, public opinion surveys have documented a troublesome erosion of public trust in the healthcare system. For example, in 2015 only 37 percent of the public told Gallup that they had a “great deal” or “quite a lot” of confidence in the medical system, compared to 80 percent in 1975. This year’s American Board of Internal Medicine (ABIM) Foundation Forum, held from July 28-31 in New Mexico, focused solely on addressing the growing lack of trust in the medical profession.
At the conference, Dr. Adam Berinsky, a professor of economics at MIT who specializes in the fields of political behavior and public opinion, reported that over the last 5-10 years, the United States has experienced an unprecedented loss of trust in government, business leaders, and expert’s testimony, while also experiencing a lesser - yet still troublesome - erosion of trust in science and medicine. The 2018 Edelman Trust Barometer confirmed these observations as their survey of 28 global markets showed that the United States had the steepest dip in trust in healthcare from 2017-2018.
The current atmosphere of political polarization, “fake news,” political attacks on traditional media, the rise in the use of the Internet as a news source, and the publication of conflicting findings from various scientific studies have, undoubtedly, all played a role in the erosion of trust. And while the reasons for this decline in trust in medicine are not abundantly clear, the implications for businesses and all who serve the public are significant, as trust is a fundamental element that facilitates all human transactions.
So how can trust be restored?
At the ABIM Forum, a bevy of key healthcare leaders commented on their experience with gaining or losing trust and highlighted the following:
- Tom Lee, CEO of Press Ganey, reported on a survey they conducted involving over 9,000 outpatients. The patients who recommended their own providers to others did so mostly due to perceived competence and perceived provider concern for the issues most worrisome to the patient. He noted that while most surveys indicate that patients still trust their physicians, they are continuing to lose trust in the medical profession in general.
- Gary Kaplan, CEO of Virginia Mason Health Systems, reported on the use of frequent face-to-face meetings with provider leaders and strong commitments to transparency and quality as a way to build trust within a medical community.
- Don Berwick, the former head of CMS, spoke of efforts to restore provider trust as well as legislators’ trust in CMS by increasing transparency, leveraging a large staff of skilled and dedicated MDs and RNs at CMS, increasing external meetings with providers, and targeting trust as something to work on collaboratively.
The following tools, discussed at the Forum, were found to increase trust:
- reliance on information imparted by your doctor
- increased use of nurses or pharmacists, as these professions are also well-regarded
- empathy and friendliness
- good social skills
- transparency and use of trusted third party information (example: CDC)
- clarity and accuracy
Shared decision making, a process that encourages physicians and patients to collaborate on treatment decisions, has proven to result in improved patient satisfaction and a reduction in unnecessary higher-cost options. This success may be because the shared decision making process relies upon transparency (sharing unbiased information on benefits and risks) and upon strengthening the relationship between the provider and the patient.
Over the past 20 years, Health Dialog’s shared decision making solutions have empowered patients to manage their care and make informed decisions on a range of conditions, such as knee and hip osteoarthritis, back pain, cancer, cardiovascular disease, and more. An independent study conducted by Group Health and published in Health Affairs, titled “Introducing Decision Aids At Group Health Was Linked To Sharply Lower Hip And Knee Surgery Rates And Costs,” analyzed results from the use of Health Dialog’s Shared Decision Making tools.
Results from the study include:
- Knee replacement surgeries declined by 38%
- Hip replacement surgeries declined by 26%
- Costs declined by 12-21%
Partners Healthcare System has been using Health Dialog’s decision aids for many years as part of their routine care. Over the years they have published a number of scientific studies on their effectiveness. Thomas Ca, MD, MBA, co-authored a study published in 2017 which found that patients who used Health Dialog’s aids prior to their orthopedic consultation were more satisfied with their care than the control group, regardless of whether they ultimately opted for surgery.
To learn how shared decision making can increase trust and result in more evidence-based medical care, check out my recent video: Patients are from Mars. Doctors are from Venus.