(Mis-) Trust in Healthcare

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Blog post by Joe Babaian

It’s the kind of mistrust of science because science is viewed as authority. And there’s a lot of anti-authority feeling. I think that’s the kind of thing that drives the anti-vaxxers, the people who don’t believe the science of vaccination and don’t want to get their children vaccinated. It’s all part of that trend, which is very disturbing.

~Dr. Anthony Fauci

Trust in healthcare and science – the system and the medical profession is rooted in experience, connections, and perception. Different segments of society have varying levels of trust based on socio-economic status, race, and level of interaction with the healthcare system to name a few. You can see social determinants of health #SDoH and demographics being a large part of this equation.

Who do we trust and why? Do we have the tools to differentiate between helpful marketing that aims to inform versus the darkly-shaded ask of pharmaceutical marketing that often does not align with best practices?

Trust in healthcare has been declining and, most concerningly, has accelerated during the current COVID-19 Pandemic. Some sobering facts from the NEJM and the NY Times:

In 1966, more than three-fourths of Americans had great confidence in medical leaders; today, only 34 percent do. Compared with people in other developed countries, Americans are considerably less likely to trust doctors, and only a quarter express confidence in the health system.

During some recent disease outbreaks, less than one-third of Americans said they trusted public health officials to share complete and accurate information. Only 14 percent trust the federal government to do what’s right most of the time.

Imagine – public health emergencies where less than one-third of the people trust the news they receive plus even fewer trusting the government to do the right thing. This is a recipe for disaster.

Some further impacts found from decreased trust in healthcare:

  • Patients less likely to follow treatment plans
  • Patients more likely to decline critical vaccinations for themselves or children
  • People less likely to follow medical advice for lifestyle & family planning issues
  • Hurting innovation & research – clinical trial enrollment based on patient trust in their doctor – study
  • Acceptance and use of #DigitalHealth – wearables, EHR, and more based on trust that privacy will be maintained (or not)
  • Stalled #telehealth / #telemedicine adoption (or pull back) – even in a time of COVID-19.

What can we do?

  • Partnering with patients versus “treating” patients
  • Education. Education. Education.
  • Improving communication and transparency – @myopennotes for example
  • Empathy in all interactions
  • Use new, secure technologies such as #blockchain to assure privacy/security
  • Fostering and creating a collaboration mindset – tear down walls

Let’s talk about trust in healthcare as we join the extended #hcldr community for another engaging dialog.

Please join me on Tuesday, July 14th at 8:30pm ET for the weekly #hcldr tweetchat where we will be discussing trust:

  • T1 How have you seen lack of trust in science & healthcare impact the world during this period as we face COVID-19?
  • T2 How might the disturbing trend of science being viewed as an authority to mistrust & reject create a generational wave of primary and knock-on effects?
  • T3 What can be done to reverse the trend of reduced trust in healthcare / science as me move forward?
  • T4 How do you see the trust issue evolving? Will new innovations/leadership help or hinder fostering more trust? Will the lessons be painful?

References

Bachai, Sabrina. “Black Americans Don’t Trust Our Healthcare System — Here’s Why.” Text. The Hill, August 24, 2017. http://thehill.com/blogs/pundits-blog/healthcare/347780-black-americans-dont-have-trust-in-our-healthcare-system.

Baruah, MD, Biswajit. “The Importance of Trust in Healthcare | LinkedIn.” LinkedIn.com, January 5, 2017. https://www.linkedin.com/pulse/importance-trust-healthcare-biswajit-dutta-baruah/.

Birkhäuer, Johanna, Jens Gaab, Joe Kossowsky, Sebastian Hasler, Peter Krummenacher, Christoph Werner, and Heike Gerger. “Trust in the Health Care Professional and Health Outcome: A Meta-Analysis.” PLOS ONE 12, no. 2 (February 7, 2017): e0170988. https://doi.org/10.1371/journal.pone.0170988.

Blendon, Robert J., John M. Benson, and Joachim O. Hero. “Public Trust in Physicians — U.S. Medicine in International Perspective.” New England Journal of Medicine 371, no. 17 (October 23, 2014): 1570–72. https://doi.org/10.1056/NEJMp1407373.

De Lombaerde, Geert. “ReviveHealth Study: Trust in Health Care System Still Declining | Nashville Post,” September 25, 2017. https://www.nashvillepost.com/business/health-care/article/20976737/revivehealth-study-trust-in-health-care-system-still-declining.

Graham, James L., Lokesh Shahani, Richard M. Grimes, Christine Hartman, and Thomas P. Giordano. “The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care.” AIDS Patient Care and STDs 29, no. 12 (December 1, 2015): 661. https://doi.org/10.1089/apc.2015.0156.

Keckley, Paul. “The Trust Chasm in Health Care: Analysis of the 2016 Trust Survey,” November 2, 2016. https://www.hhnmag.com/articles/7802-the-trust-chasm-in-healthcare-analysis-of-the-2016-trust-survey.

Khullar, Dhruv. “Do You Trust the Medical Profession?” The New York Times, January 23, 2018, sec. The Upshot. https://www.nytimes.com/2018/01/23/upshot/do-you-trust-the-medical-profession.html.

Kvalnes, Øyvind. “Fallibility and Trust in Healthcare.” In Fallibility at Work, 79–99. Palgrave Macmillan, Cham, 2017. https://doi.org/10.1007/978-3-319-63318-3_5.

“OpenNotes: How the Power of Knowing Can Change Health Care.” NEJM Catalyst, October 12, 2017. https://catalyst.nejm.org/opennotes-knowing-change-health-care/.

Penman, D. T., J. C. Holland, G. F. Bahna, G. Morrow, A. H. Schmale, L. R. Derogatis, C. L. Carnrike, and R. Cherry. “Informed Consent for Investigational Chemotherapy: Patients’ and Physicians’ Perceptions.” Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 2, no. 7 (July 1984): 849–55. https://doi.org/10.1200/JCO.1984.2.7.849.

Reeves, Jerry. “The Four C’s of Rebuilding Trust in Health Care,” October 29, 2014. https://healthinsight.org/about-us/healthinsight-blog/entry/1-healthinsight-blog/63-the-four-c’s-of-rebuilding-trust-in-health-care.

Shirra, Doug. “Blockchain: Pharma’s Answer To Restoring Trust In Healthcare.” Digitalist Magazine, December 4, 2017. http://www.digitalistmag.com/digital-economy/2017/12/04/blockchain-pharmas-answer-to-restoring-trust-in-healthcare-05593392.

Steel-Fisher, Gillian K., Robert J. Blendon, and Narayani Lasala-Blanco. “Ebola in the United States — Public Reactions and Implications.” New England Journal of Medicine 373, no. 9 (August 27, 2015): 789–91. https://doi.org/10.1056/NEJMp1506290.

“Still Not Convinced You Need a Flu Shot? First, It’s Not All About You.” The New York Times, January 15, 2018, sec. The Upshot. https://www.nytimes.com/2018/01/15/upshot/flu-shot-deaths-herd-immunity.html.

Thom, David H., Mark A. Hall, and L. Gregory Pawlson. “Measuring Patients’ Trust In Physicians When Assessing Quality Of Care.” Health Affairs 23, no. 4 (July 1, 2004): 124–32. https://doi.org/10.1377/hlthaff.23.4.124.

“Trust and Communication in Healthcare: Key Findings | The Trust Project.” THE TRUST PROJECT AT NORTHWESTERN UNIVERSITY. Accessed July 7, 2020. http://www.kellogg.northwestern.edu/trust-project/videos/michelson-ep-2.aspx.

“Trust in Healthcare Undermined by ‘bad Apples,’ New Research Reveals.” ScienceDaily, November 3, 2017. https://www.sciencedaily.com/releases/2017/11/171103085701.htm.

Image Credit

1918 Kansas Flu – Public Domain

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