Blog post by Bernadette Keefe MD
Breaking someone’s trust is like crumpling up a piece of paper. You can smooth it over but its never going to be the same again.
There is perhaps no more central concept to human communication and relationships than trust: “belief that someone or something is reliable,good,honest,effective”. This holds true for our professional (business-ie financial, insurance, governmental, healthcare etc) as well as our personal interactions. Once established, trust allows unbridled, open and honest discussion and limitless learning. A trusting environment fosters personal growth, self esteem and generosity. Trust allows the deepest love humans can have. Trust leads to peace.
The absence of trust breeds the opposite of the above. Deep and open relationships are not possible. Communication breaks down on all levels and realms. Unfortunately, overtime we have experienced a breakdown of trust between the people and much of society’s organizational structure: business, government, academia, scientific and healthcare communities. Physicians as messengers are swept up in this tide of mistrust. If the messengers/teachers/researchers of science, education and medicine are not trusted their messages,no matter how factual, will not be accepted and advice will not be adhered to. Gone, happily, are the days of “blind trust” but the atmosphere of “no trust” is equally untenable.
“You don’t want to get into a situation in which your doubt takes you into…conspiracy,junk. The moon landing was not faked”-@JoelAchenbach
— The Diane Rehm Show (@drshow) March 4, 2015
Basis for Mistrust
Some of mistrust has roots in emotion, superficiality and insufficient thought. However, there are multiple historical and current reasons for mistrust of health related research, healthcare professionals, healthcare delivery systems, pharmaceutical companies etc. Past betrayals, lack of transparency, dishonest or poor research, conflict of interest, need for multiple retractions, abundant conflicting research, high costs in a profit driven industry (USA), error rates, safety issues, poor communication of scientific knowledge, patriarchy etc all contribute to a climate of mistrust. Today poor quality of end of life care, hospital infections and safety issues, a hurried medical system, issues around data access and data privacy, lack of clear communication coupled with low rates of general literacy and health literacy all contribute to the erosion of trust between healthcare systems / providers and the people they serve.
On the flip side, inflated and unreasonable expectations that medical care can/should cure our multiple lifestyle diseases (with a pill), all infections need antibiotics, and that death can/should be put off forever- when unmet- generate unfounded anger and mistrust.
The media has a role to play in mistrust of messages from the scientific and healthcare communities. If the media goal is to educate the public by reporting facts both the scientific community and the people win. If the media goal is to make money by hyping headlines which are misleading, useless or both: everyone loses, with trust as the biggest loss. Snake oil salespersons masquerading as healthcare professionals don’t help.
Pathways to Rebuild Trust
On the disconnect between science and people’s perception of science Dan Vergano of National Geographic wrote:
Scientists say that this points to the shortcomings in their own skills at reaching out to the public, and to deficits in science education.
The above statement could equally apply to healthcare (re some physicians communications and the recognized low literacy and health literacy rates of the general populace). Although access to information has been revolutionized with the Internet, some of the best information is proprietary, behind paywalls.
There are multiple actions that can be taken now to rebuild trust:
- Educate the general public on the basics of the scientific method: a process of trial and error, of testing hypotheses. Truthfulness of results depend on rigorous methods and data collection and interpretation as well as reproducibility. To this last point, researchers have an obligation to open their clinical trial data to allow appropriate review and verification. Communicators of the information should present conclusions in a neutral and appropriate manner so essential truths of the research are understood by the public. Researchers can help by being honest about the limitations of their work.
- All citizens can vote to support appropriate levels of funding for our public schools so the populace can be educated. Educated citizens are essential for good governance and a nation’s health. We will never get to “population health” without an educated citizenry. Additionally medical information must be more available to the general public, in a better organized manner and in language suitable for the average reader.
- Scientists and healthcare professionals must learn to communicate in more compassionate, empathic and open ways. Today’s information age places the onus on scientists and physicians to reach out to the public, listen to questions, address doubts and make smart efforts to understand people’s positions and fears. Such engagement lays the groundwork for the trust needed to successfully convey information. Gaps in communication are usually filled with rumor, conjecture and hype. Ridiculing or attacking people who have uninformed views is not conducive to successful communication or fostering trust.
- Healthcare systems,hospitals,insurance companies can go a long way to improving trust with the people (their consumers/patients) through cost and price transparency, consistent policies, clear communication, and addressing safety issues and error as a number one priority.
- Finally, to close the Circle of Trust, people have to make good faith efforts to address their lifestyle medical issues through learning about the diseases, adhering to agreed upon treatment protocols, exercising adequately, adopting healthy eating habits etc. Also people and their families must face mortality much earlier and discuss end of life and aging issues while they still can. This takes courage and discipline. Are we just punting these uncomfortable conversations? Healthcare professionals are depending on our having talked over these important issues with family members before landing in the Intensive Care Unit. Do we have an Advanced Care Directive on file with our MD?
Trust is a two way deal. One side can trust initially, but to be sustained, the other party must live up to their side of the bargain. Have trust, then verify or it will erode.
On Tuesday March 10th at 8:30pm Eastern (for your local time click here), join the #hcldr tweetchat as we discuss trust in healthcare (and science):
- T1 Personal or general examples of erosion of trust in healthcare and science? Why do you think it occurred?
- T2 Good examples of individuals or organizations in healthcare garnering the public trust?
- T3 Suggest specific ways to build trust in the healthcare and scientific realms
- T4 Over time, will the information age with its transparency, virility & hype – build or erode trust in healthcare/science?
“Why We Doubt Scientific Findings”, The Diane Rehm Show, March 4 2015 http://thedianerehmshow.org/shows/2015-03-04/why-we-doubt-scientific-findings, accessed March 6 2015
“Why Do Many Reasonable People Doubt Science”, Joel Achenback, National Geographic, March 2015, http://ngm.nationalgeographic.com/2015/03/science-doubters/achenbach-text, accessed March 6 2015
“Poll Reveals Rift Between Science and Regular Folks”, Dan Vergano, National Geographic, January 29 2015, http://news.nationalgeographic.com/news/2015/01/150129-public-opinion-aaas-health-education-science/, accessed March 6 2015
“Why You Trust The Internet More Than Your Doctor”, The Daily Beast, February 26 2015, www.thedailybeast.com/articles/2015/02/26/why-you-trust-the-internet-more-than-your-doctor.html?via=twitter_page, accessed March 6 2015
“Anthem Sued Over Large Data Breach By California Consumer”, Edvard Pettersson, Bloomberg, February 5 2015, http://www.bloomberg.com/news/articles/2015-02-06/anthem-sued-in-california-by-consumer-over-massive-data-breach, accessed March 6 2015
“Reasons Why I Do Not Trust the Mainstream Health Authorities”, Kris Gunnars, Authority Nutrition, http://authoritynutrition.com/6-reasons-i-do-not-trust-mainstream-health-authorities/, accessed March 6 2015
“Good Morning, My Name is Aara : Building Trust in Health Care”, Robert J Bledon et al, New England Journal of Medicine, October 29 2014, http://www.nejm.org/doi/full/10.1056/NEJMp1407373#t=article, accessed March 6 2015
“A Closer Look At Public Trust in Healthcare”, Paul Keckley, The Health Care Blog, May 2014, http://thehealthcareblog.com/blog/2014/05/22/a-closer-look-at-public-trust-in-healthcare/comment-page-1/, accessed March 6 2015
“What can physicians and scientists do to increase public trust in vaccines?”, Association of American Medical Colleges, https://www.aamc.org/initiatives/research/perspectives/#.VNp1FDy-Q2Y.twitter, accessed March 6 2015
“Why Don’t People Trust Science”, Tom Spears, Ottawa Citizen, February 21 2015, http://ottawacitizen.com/news/national/why-dont-people-trust-science, accessed March 6 2015
Overcoming writer’s block – crumpled paper on wooden floor – crushed paper – photosteve101