The Erosion of Trust in Healthcare: How Did We Get Here?
Every year, the ABIM Foundation convenes medical leaders from around the country to discuss the challenges of delivering quality medical care. For the past two years, the foundation has devoted its annual meeting to addressing the topic of trust in healthcare. I’m grateful to have been included in these meetings, and I wanted to share some insights with you regarding this important topic.
According to recent studies, “a higher level of trust in medical providers is associated with superior patient outcomes, such as more favorable long-term glycemic control and higher health-related quality of life, patient satisfaction, and fulfillment of medical needs.”
When I practiced internal medicine in the Boston suburbs, I managed patients who faced significant health problems. Despite my experience and expertise, gaining their trust (and their buy-in) was the most important part of my job. After all, for my guidance to be effective, I needed them to listen to it, understand it, and actually follow through on it. For instance, what good is medication if your patients don’t take it?
If you are in the business of helping people manage their health, you are in the business of building trust. Unfortunately, trust in our industry is at an all-time low. Let’s take a look at some startling facts:
- In 1966, 73% of US residents had confidence in their medical leaders; in 2012, that number declined to 34%.
- In a 2014 survey of 1608 participants, only 31% indicated they trusted public health officials to share complete and accurate information during disease outbreaks.
- In a 2017 survey of 1009 participants, only 18% expressed high levels of confidence in the US health system.
Trust issues affect all of us who work to deliver healthcare services. According to the 2018-2019 ACSI Finance, Insurance, and Health Care Report, consumer satisfaction with health plans is low compared to other non-healthcare businesses, and satisfaction with hospitals is especially poor—and declining.
How does the US compare to the rest of the world? Globally, the US tied for 24th place in terms of the proportion of adults who agree with the statement, “All things considered, doctors in [your country] can be trusted.” About 58% of US adults agreed with this statement, compared with 83% in Switzerland, 79% in Denmark, 76% in Britain, 73% in Australia, 70% in South Africa, and 68% in the Philippines (ISSP 2011–2013.
How did we get here?
It’s clear that the erosion of the public’s trust in healthcare is part of a broader cultural shift that involves many institutions, including government agencies, the media, and for-profit businesses. Recent events and innovations make it seemingly easy to understand how the public may have become more distrustful:
- Healthcare is the leading cause of personal bankruptcy; lack of cost transparency and surprise bills continue to garner public attention
- The opioid crisis and the charges against companies such as Purdue Pharmaceuticals, Johnson & Johnson, and the arrests of physicians who run pill mills
- The high-profile case of Theranos, now famous for their blatantly false claims regarding lab testing
- The unsubstantiated, almost-comical claims made on television by Dr. Oz for numerous “miracle” products
- The internet, the ubiquitous source of medical information, gives access to both the best, scientifically-robust information as well as medical claims that are clearly biased and misleading
What Are the Health Consequences Caused by Loss of Trust?
The erosion of trust in healthcare has already had a significant impact on quality outcomes. Case in point: vaccines. According to the CDC, less than half of Americans were vaccinated against the flu during the 2017-2018 season. Yet, millions of people get the flu each year and (depending on the year) thousands to tens of thousands die from flu complications. Vaccines have been proven to be safe and effective in alleviating disease and suffering, yet vaccine ignorance and misinformation have added to the general lack of trust in their safety.
In 2019, the US had the largest number of measles cases since 1992. Measles, one of the most communicable diseases, spreads mainly in communities where groups of people are unvaccinated. In Europe, recent outcomes were even worst. The hardest hit country in Western Europe with the measles epidemic was France, which has the lowest rates of vaccinations, and the worst scores on public trust in vaccines.