Q&A: ABIM offers solutions to address ‘earned mistrust’ in medical community

The public’s trust in the medical community is beginning to erode, but health care professionals can take action to help restore it, ABIM President and CEO Richard J. Baron, MD, MACP, told Healio Primary Care.

“In recent years, we have seen many harmful attempts to undermine science and to sow doubt about medical evidence,” he said. “Everyone in the health care system needs to get better at building trust as a foundation for successfully engaging patients who approach the current system with earned mistrust and often do not benefit from the best that medical science could offer.

“Mistrust is a breeding ground for poor outcomes, and in the current environment, a longer, more lethal pandemic,” Baron continued. “None of us want that.”

To address this issue, the ABIM Foundation focused its 2020 forum on building trust and improving health equity. Baron and Dhruv Khullar, MD, a hospitalist at Weill Cornell Medicine in New York, recently co-authored a paper in Annals of Internal Medicine that highlighted some of the strategies that were presented at the forum, including:

• a virtual reality program designed to simulate the experience of being Black as a way for users to develop more empathy;
• an artificial intelligence algorithm that aims to reduce bias, as current AI systems have been shown to favor white patients over Black patients;
• a session on humility about why disadvantaged populations, such as the homeless, may not trust physicians; and
• a strategy to increase public health resources, with a goal of reducing the structural inequities that result in health disparities.

Below, Baron discusses some of the key takeaways from the forum.

Q: Which strategies presented at the forum appear to be the most promising?

A: The forum sought to convene leaders in health care working on promising initiatives aimed at addressing inequities in care.

Diversifying our workforce and strengthening our public health system would have extraordinary reach and impact for patients and clinicians across the health care system and for society as a whole. The four interventions described in the Annals of Internal Medicine paper are good examples of areas that can make a real-world impact in a variety of ways.

One project we thought was particularly novel was the use of virtual reality to allow someone to experience bias from a first-person perspective. We believe this could help those who haven’t themselves been subjected to bias have greater empathy for those who have, and possibly become more open to initiatives aimed at addressing them.

Q: How will these strategies you identified create a more equitable health care system?

A: All of these strategies support better care for people who are often poorly served by our existing system. They would improve access to care for those experiencing homelessness or lacking community resources and improve quality of care for members of underserved populations who may lack trust in the care they receive. A common theme is offering examples for how health systems everywhere can build trust, which will be essential if they are to better serve their communities. Taken together, these strategies could put us on a path toward a fairer system.

Q: What financial and staffing resources are needed to bring these strategies to fruition? What financial assistance programs exist to support these strategies?

A: Many of these projects will require institutional leaders working at the local level to better understand their communities and their needs; different institutions will be able to leverage different existing resources and likely need to sort out what new resources they may need.

One overarching issue in the United States is the continued lack of public health funding, which today represents less than 3% of all dollars spent on health care. By bolstering public health capacity, we know we can address many of the underlying social determinants that can undermine health in underserved communities and collectively improve the health of our nation.

There are some organizations working to provide financial support for these strategies, but it will certainly require more than what has been dedicated historically. This is why ABIM and the ABIM Foundation are co-sponsoring a $300,000 grant program with the Alliance for Academic Medicine, the ACP and Josiah Macy Jr. Foundation aimed at building trust within internal medicine education by supporting projects designed to enhance diversity, equity and inclusion.

Reference:

Baron RJ, Khullar D. Ann Intern Med. 2021;doi:10.7326/M20-6984.