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At the core of every successful, fulfilling, lasting relationship is trust. Lost trust rips marriages apart. No company succeeds when team members don’t trust each other. Building trust takes time, yet it can be lost in the blink of an eye, and when trust is lost, it’s difficult, sometimes impossible, to regain.
Historically, society’s institutional trust was conveyed from the top, exemplified by the American motto, “In God We Trust.” People trusted their religious and government institutions and leaders. However, according to the 2019 Edelman Trust Barometer, just one-third of Americans currently trust their government “to do the right thing.”
Since the turn of the century, as the internet has redefined how we live, learn, and behave, who and what we trust has changed dramatically. Rather than blindly placing our trust in traditional authority figures, we now look to our peers and like-minded individuals.
Sadly, we don’t trust each other much either. Edelman found that over the last 20 years, Americans have less confidence in each other, and 29 percent say they don’t trust their neighbors or fellow citizens.
I believe the erosion of trust in society has serious implications for public health and well-being, because science is also based on trust: trust, but verify. When society loses trust in medicine, this imperils the health of every individual.
As a physician, I must trust the science that informs my clinical recommendations, that researchers are ethical, and the data they produce is accurate. My patients must trust that I keep up-to-date by reading the latest research, and most importantly, that their well-being is at the core of every recommendation I make.
Over the last 50 years, trust in physicians has dropped dramatically. In 1966, 74% of Americans had “great confidence” in the medical profession, but by 2012, this number dropped to just 34%. Citizens don’t trust the healthcare system and they lack confidence regarding whether their personal well-being is the most important driver of medical decisions.
The best example of society’s eroded trust in medicine is the persistence and power of the anti-vaccination movement. Despite mountains of evidence to the contrary, anti-vaxxers continue to propagate completely discredited research, encouraging frightened parents to forgo vaccinating their children.
Vaccinations are one of the most important life-saving measures ever developed, yet we now have a resurgence of nearly eradicated, deadly diseases, putting the lives of those too young to be vaccinated, and the immunocompromised, in peril.
Despite my 20 years of clinical experience as a psychiatrist, I’ve had to spar with my own family members regarding their inaccurate medical beliefs, which were based on their faith in “Dr. Google.”
My patients are routinely terrified by sensational news headlines based on a few cherry-picked lines from a scientific article. A 2019 headline, “ADHD treatments double the risk of psychosis,” was based on a paper that showed the risk increased from 0.1% to 0.2%. While indeed the risk doubled, that meant that out of every 1,000 people treated with stimulant medication, two people experienced psychosis, which the authors stipulated could have been associated with illicit drug use.
Considering the benefits of well-treated ADHD, most clinicians and patients agree that the risk-benefit analysis overwhelmingly favors treatment, yet that scary headline is enough to cause anyone to consider discontinuing treatment.
How do we turn the tide and start to rebuild trust in medicine?
Patient-centered care: Each patient must be treated as an individual and every treatment decision must be based on their individual needs. Physicians must be sensitive to their patient’s unique social, cultural, economic, and familial circumstances.
Patients might not remember exactly what you said or what you did, but they will definitely remember how you made them feel. Physicians who fail to treat patients with kindness and compassion, and those who don’t practice with integrity, don’t just poison their relationship with that patient, they tarnish and dishonor our profession.
Physician, heal thyself: Sometimes physicians lose compassion for patients because of burnout, which is at epidemic levels. National surveys evaluating doctors and trainees have found prevalence rates greater than 50%. Along with emotional exhaustion and a low sense of accomplishment, burnout builds cynicism, which may be directed towards patients.
Overcoming burnout isn’t easy, especially since research shows that physician-focused interventions, such as increasing exercise, are not nearly as effective as institutional changes. Such changes require motivated, visionary leadership.
Patient education: The time spent educating patients about their illness and treatment is as valuable as the time it takes to diagnose the disorder. That’s because no treatment will work if it’s not taken and patients don’t take treatments they don’t trust. They might not fully understand or remember how the treatment works, but they will remember that what you told them was reassuring and made sense, which builds trust.
By integrating accessible, high-quality educational material into every medical interaction, patients learn and feel empowered as a result. This also heightens the quality of the information patients receive (in contrast to what Dr. Google has to offer).
Regulating Big Pharma: While I believe in the value of research and development, the unethical conduct of some pharmaceutical companies has done lasting damage to the trust society has for the industry and their products. Monitoring and regulations imposed on the pharmaceutical industry, including requiring companies to report all research findings, no matter the outcome, was necessary, but ongoing vigilance is essential.
In addition, the integration of healthcare technology, improving relationships between allied healthcare professionals, and many more opportunities exist to rebuild trust in medicine.
Reassuringly, Edelman found that despite society’s deep pessimism and historically low levels of trust in institutions, two-thirds of people continue to have faith in the honesty and integrity of physicians. Considering the societal impact of losing trust in the institution of medicine, working to rebuild trust is clearly worth the investment of time and treasure.
Moran LV, Ongur D, et al. (2019) N Engl J Med; 380:1128-1138
Rothenberger, David A. Diseases of the Colon & Rectum, Volume 60, Number 6, June 2017, pp. 567-576(10)