Your Patients Don't Trust You. Here's How to Fix it

CMOs and other healthcare leaders need to employ several strategies to restore trust, such as pushing back on misinformation about who profits from vaccines.

Trust in physicians and hospitals fell from 71.5% in April 2020 to 40.1% in January 2024, according to a new research article.

The trust patients place in physicians and hospitals is an important concern for CMOs and public health officials. If patients do not trust physicians and hospitals, they are less likely to follow their recommendations.

The coronavirus pandemic marks a turning point for trust in physicians and hospitals, says the lead author of the research article, Roy Perlis, MD, MSc, associate chief of research in the Department of Psychiatry and director of the Center for Quantitative Health at Massachusetts General Hospital.

"Prior to the pandemic, many physicians took it for granted that people would trust them," Perlis says. "Unfortunately, because there was so much misinformation and politicalization of healthcare during the pandemic, a lot of the initial trust in physicians and hospitals was squandered. What we have realized is that we need to rebuild trust if we are going to support public health in the future."

The loss of trust during the pandemic was not a surprise for the researchers, according to Perlis.

"Unfortunately, during the course of the pandemic, especially with the spread of misinformation about COVID and the vaccine, trust declined substantially," Perlis says. "We were not surprised that trust declined, but we were surprised by the magnitude of the drop."

The research article is based on survey data collected from more than 440,000 U.S. adults. In addition to the finding that trust in physicians and hospitals dropped 31%, the study, which was published in JAMA Network Open, includes three key results:

• Higher levels of trust were associated with a higher chance of vaccination for COVID-19 (adjusted odds ratio 4.94) or influenza (adjusted odds ratio 5.09), as well as getting a COVID-19 booster (adjusted odds ratio 3.62).
   
• Characteristics linked to decreased trust included being 25 to 64 years of age, female, lower educational level, lower income, Black, and living in a rural area.
   
• When survey respondents were asked why they had lower levels of trust, the reasons cited included financial motives over patient care, poor quality of care and negligence, influence of external entities and agendas, and discrimination and bias.

Roy Perlis, MD, MSc, is associate chief of research in the Department of Psychiatry and director of the Center for Quantitative Health at Massachusetts General Hospital. Photo courtesy of Mass General Brigham.

Trust is essential to convince patients to follow recommendations such as vaccination, according to Perlis.

"If your doctor is telling you to do something either directly or through the hospital where you get your care, there is no reason to follow the recommendations if you do not trust what you are being told about something like vaccination," Perlis says. "That is one of the reasons why it is imperative that we restore trust."

Loss of trust is different for different groups, according to Perlis.

"Some of them may be more likely to have had bad experiences with healthcare. Historically, we know that we have not necessarily treated all groups equally well," Perlis says. "Unfortunately, public health became politicized during the pandemic, and some of the groups that were associated with less trust had more exposure to the politicization of healthcare."

For survey respondents, the reasons for loss of trust broke down into several categories, according to Perlis:

• One reason was bad experiences in terms of their own care or the care of a family member.
   
• There were concerns about conflicts of interest.
   
• People were worried that doctors or hospitals may have financial motives rather than simply being focused on providing the best care.
   
• There was concern that doctors or hospitals might be influenced by outside entities or outside agendas.
   
• There was a subset of survey respondents who had experienced discrimination or bias in their interaction with the healthcare system.

Restoring trust in doctors and hospitals

There are several steps that CMOs and other healthcare leaders can take to restore trust, according to Perlis.

"It is one thing to say trust is down," Perlis says. "It is another thing to think about how we can repair trust, which we will need for all kinds of public health initiatives, including the next pandemic and anything that involves intervening to improve public health. We absolutely must prioritize restoring trust."

Strategies to restore trust will have to be crafted with the reasons why trust has eroded.

"The strategies to restore trust probably aren't a one-size-fits-all response," Perlis says. "They need to address some of the underlying concerns."

There are several ways that CMOs and other healthcare leaders can show people that conflict of interest does not drive decision-making.

"For example, we have transparency laws that make it easy for people to see whether their doctor is being paid by someone other than the hospital," Perlis says.

CMOs and other healthcare leaders need to push back on misinformation about who profits from things such as vaccines or medications.

"Simply clarifying who pays for these things and who benefits from them financially is important," Perlis says.

For people who have had bad experiences with healthcare or feel they were not treated well, that is more difficult to address.

"We need to find ways to re-engage with these people," Perlis says. "One way to do that is to listen. We can get people in to see their doctor and find out why they had bad experiences."

CMOs and other healthcare leaders need to make it easier for people to interact with the healthcare system.

"There are many reasons people get frustrated such as long wait times to see doctors," Perlis says. "We need more outreach and more accessibility."