Q&A: Health care community must 'take steps to rebuild trust' lost during pandemic
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Key takeaways:
- Adults’ trust in physicians and hospitals dropped markedly between April 2020 and January 2024.
- An expert discussed the reasons behind this, connected health outcomes and how to regain that trust.
Trust in health care diminished dramatically during the pandemic, and it will take multipronged interventions to restore that confidence, according to an expert.
Roy H. Perlis, MD, MSc, director of the Center for Quantitative Health at Massachusetts General Hospital, and colleagues recently published the results of a survey study that evaluated trust in physicians and hospitals in JAMA Network Open.
The survey included 582,634 responses of 443,455 unique participants aged at least 18 years in the United States. The researchers found that in April 2020, 71.5% (95% CI, 70.7%-72.2%) of adults reported a lot of trust for hospitals and physicians, but in January 2024, that number dropped to 40.1% (95% CI, 39.4%-40.7%).
After accounting for partisanship, some of the characteristics associated with lower trust included:
- female gender;
- age 25 to 64 years;
- rural setting;
- Black race;
- lower income level; and
- lower educational level.
Healio spoke with Perlis to learn more about factors behind the lost trust, what primary care providers can do to restore it and more.
Healio: Why did you evaluate trust for this study?
Perlis: During the pandemic, there was so much misinformation about COVID-19 and how to treat it, and tremendous criticism of public health leaders who sought to push back on that misinformation. We wanted to understand whether this misinformation, and the attacks on public health leaders and doctors, had impacted peoples' level of trust.
Trust in health care is important because clinicians are often the front lines when it comes to conveying messages about healthy behaviors. For example, if your doctor tells you that it's important to exercise or eat a healthy diet, it might be more likely that you'd do so. It is the same with other contributors to public health — wearing seatbelts, wearing bike helmets and so on.
Healio: What are the biggest factors contributing to the declining trust you documented?
Perlis: We can't say with confidence why trust diminished, but we did ask participants who said they had low levels of trust why they had low trust. That, to me, was one of the most interesting parts of the study. For some people, it was bad experiences with health care — feeling like they'd been mistreated, or someone in their family had been mistreated. For others, it was suspicion that doctors had conflicts of interest — that they might be trying to earn more money or unduly influenced by other groups like the U.S. government. And some people reported experiencing bias.
Healio: Did you find any connection among lower trust and specific health outcomes?
Perlis: We found that people with lower levels of trust were less likely to be vaccinated against COVID-19, as well as influenza.
Healio: How can the lost trust be restored? Who will need to be involved in the effort?
Perlis: Interventions to restore trust will need to take into account that not everyone mistrusts doctors and hospitals for the same reason. We'll likely need interventions that address several of the factors that contribute to mistrust.
Healio: What can health care workers — specifically PCPs — do to help improve trust with their patients?
Perlis: A common theme in some of the survey responses was not feeling heard — that [patients] didn't have a say in decisions. Carving out time to actually listen to patients will go a long way. In particular, when recommending a new treatment or additional tests, it's important to be clear about why we're making these recommendations. This is bedside manner 101, but in an era when there's so much pressure to see more patients, more quickly, I'm afraid the time to answer questions gets shorter and shorter.
Healio: What is the take-home message for PCPs from your study results and analysis?
Perlis: That we can't take for granted that people trust us — and that if we want to maintain an ability to promote public health, we need to acknowledge that lack of trust and start investing in rebuilding it.
Healio: Is there anything else you would like to add?
Perlis: Even though levels of trust have diminished, doctors and hospitals are still among the most trusted groups in the U.S. We cannot take that for granted — we need to push back on misinformation and take steps to rebuild trust.