Trust is increasingly hard to come by. Whether it’s the daily accusations of “fake news” that threaten our politics, declining faith in fairness under the law, or an increased prevalence of miracle cures that have no basis in scientific fact, Americans no longer easily accept what previously revered authority figures are offering.
With divisiveness and mistrust so widespread, there is little doubt that the practice of medicine is not immune. A recent Google search for “popular fake medical news” delivered a staggering 240 million results. In 2018, only 34% of the general public told Gallup that they had a positive view of the healthcare industry, compared with 1975, when 80% of the public had confidence in the medical system.
We also know from 2017 peer-reviewed research that patients who have more trust in their healthcare professionals are more satisfied with their treatment, have fewer symptoms and pursue healthier behaviors. Trusting patient-physician relationships and esprit de corps among physicians are threatened by the decline in trust, and if this trend intensifies, the consequences for healthcare could be dire. Among those, burnout, which already plagues 78% of physicians, according to a 2018 Physicians Foundation survey, could become an even greater concern. For patients, the trust deficit invites lower rates of treatment compliance leading to potentially dangerous impacts on health.
That’s why the ABIM Foundation has been thinking so deeply about trust in healthcare and how to nurture it. We believe this will ultimately help us advance medical professionalism to improve healthcare.
Research has underscored the importance of trust in achieving optimal healthcare outcomes and the effective delivery of services. A 2017 study found that breast cancer patients with the most distrust of the healthcare system were 22% more likely to report not getting at least one post-surgical treatment than patients with the least distrust.
We have learned in our exploration of trust that there are multiple drivers of low trust in healthcare, from the growth of competing and contradictory sources of information to conflicts of interest and lack of disclosure. We all know the importance of trust in relationships, but what are the specific practices or actions that ensure it?
In January, the ABIM Foundation launched a Trust Practice Challenge, an initiative to identify and promote existing practices that foster trust in healthcare. With this effort, we are seeking to be intentional about how healthcare organizations, clinical practices, and all other relationships within healthcare build trust. There is real power in treating trust as a core operating principle in the industry. We have learned from Choosing Wisely and other previous initiatives about the benefit of building trusting and respectful relationships with partners—the many stakeholders touching healthcare that can be part of the solution.
We want to expand on promising concepts that emerge from the Trust Practice Challenge by developing strategies to nurture trust, whether through combating misinformation in healthcare, strengthening ties with underserved communities, or improving communication skills for better teamwork in clinical practice.
Others can join us in pursuing greater trust in healthcare by simply making trust a topic of conversation within your settings. While there is much we still need to understand about how to advance trust, taking time to reflect on how well your institution fares on trustworthiness is a necessary starting point. Other steps such as embedding trust-building in medical education and resident training could also have an impact.
In addition, become familiar with the components of trust and what makes for strong relationships. There are varied definitions of trust, but they frequently reflect a consistent set of attributes, such as competency, integrity, transparency, compassion, reliability, confidentiality and vulnerability.
The healthcare industry is far from alone in its battle against declining trust. But what’s at risk for medicine is the erosion of the patient-physician relationship and heightened tensions between clinicians and health systems or within clinical teams, which represent perennial threats to physician well-being.