Restoring the trust in the medical profession

acp new logoA guest column by the American College of Physicians, exclusive to

Trust is the belief that another person or entity will act in your best interest, and it serves as the foundation upon which the doctor-patient relationship and our health care system are built.

But we have a significant trust paradox in American medicine. As individual physicians, we do very well in holding the public’s trust and confidence; but the medical profession as a whole, not so much.

When asked, over two-thirds of U.S. citizens rate the honesty and ethical standards of physicians as “very high” or “high,” and this percentage has actually increased slightly over the past fifty years. And surveys of individual patient satisfaction with the medical care they received during their most recent physician visit have also consistently been high.

However, public trust in the medical profession and the U.S. health care system has plummeted over this same period of time. Recent surveys show that trust in leaders of the medical profession by Americans has fallen from almost three-fourths to less than a third, and only about a quarter have confidence in the ability of the health care system to meet the needs of our country.

This “disconnect” in which we have high levels of trust in our own doctors but significant mistrust of the overall medical profession and health care system seems to be very much an American phenomenon. In a 2014 study of 29 industrialized countries, the United States was unique in that it ranked near the top in patients’ satisfaction with their own medical care, but near the bottom in trust in the country’s medical profession. These findings parallel the progressive decline of trust and confidence by the U.S. citizenry in many professions and public institutions.

But why the disconnect in trust and why is it so important?

The increasing mistrust of the medical profession undoubtedly has many causes. Our health care system is incredibly complex and extremely difficult to navigate by patients. The way in which we provide medical care in the U.S. has been and remains both tumultuous and highly politically-charged. And there continues to be unequal access to health care by certain demographic and socioeconomic groups, which likely accounts for even lower levels of trust seen in many minorities and those in lower income brackets.

Organized medicine is highly fragmented, does not tend to speak with one voice, and at times may seem internally conflicted with the resulting perception that the medical profession is either unwilling or unable to meaningfully influence these important issues for the benefit of those who are dependent on the health care system.

Add to this increasing public skepticism of the scientific underpinnings of health care that undermines the credibility that this knowledge gives medicine, and the progressive “commercialization” of many aspects of health care which legitimately raises public concerns about whether physicians truly have the best interests of patients as a focus of what we do.

No wonder there has been erosion of trust in the medical profession.

This increasing mistrust of the medical profession has potentially dangerous consequences. Being able to trust medicine as a societal institution is vital for our social, economic, and physical well-being. Without the public’s trust, the profession’s ability to influence our nation’s health and health care system is markedly diminished. Potentially lost is the voice of medicine in advocating for the best interests of patients and what we need to do collectively as a society to keep healthy. This ranges from high-level health policy to practical issues of availability and access to medical care that is essential for the public’s health. Also potentially lost is the credibility of the medical profession to apply the best science for the betterment of society as well as individual patients – think of the weakening of vaccination programs and the ability of governments and public health agencies to respond appropriately to epidemics. And it is difficult to believe that continued declining trust in medicine won’t eventually permeate down to the individual doctor-patient level.

What needs to be done to reestablish trust in the medical profession? The good news is that we retain the confidence of the public in the context of the individual doctor-patient relationship, and this is an important place to start. It allows us in real-life situations to continue demonstrating that physicians do have the best interests of patients as the primary focus of our work.

However, as a profession we need to increasingly be seen as a catalyst for helping solve the major issues confronting American medicine and our health care system today. Although organized medicine will always be responsible for advocating for physicians to help them do their jobs better, from a societal perspective it is vitally important that the medical profession stand as a unified voice for the basic human values that underlie the practice of medicine and seek to uphold the highest standards of medical care for both individuals and the public. In practical terms, this would involve taking the lead in nonpartisan efforts to improve our health care system such as addressing issues of access to and the costs of health care, particularly for the most vulnerable in society; taking more visible and definitive positions on issues affecting people’s health based on science and best evidence; and actively advocating for medical practices that provide high quality, patient-centered care.

Doing these things would not be easy given the current state of medicine and the medical profession. But only through clear, transparent, and collective actions based on the core principles that bind us together as physicians will we be able to demonstrate trustworthiness as a profession and begin to re-earn the trust and confidence of the patients we are committed to serve.

Perhaps it should no longer be “trust me – I’m a doctor,“ but rather, “trust us – we are your doctors.”

Philip A. Masters is vice-president, Membership and International Programs, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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