Patient trust is the foundation of positive patient-provider relationships and fundamental for effective treatment. Trust impacts everything from treatment adherence to health outcomes and behaviors to the likelihood of a patient returning to a provider.
Unfortunately, patient distrust in the healthcare system has been growing over the last half century and has, undoubtedly, been exacerbated by the COVID-19 pandemic. And while patient distrust of their providers has not declined to the degree to which distrust in the system itself has, it has certainly taken a hit in recent years.
In fact, in a recent survey on patient trust, more than a third of participants said they skipped or avoided care because they did not like the way the healthcare provider or staff treated them. And nearly 80% of the participants said they would not return to the same provider if they had an experience where they lost trust (Read et al., 2021).
But why have we seen this decline in trust? And what can we do about it?
There are countless theories surrounding why patients distrust their providers, but some of the more commonly cited reasons include:
- Experiences during which patients felt their providers discounted their symptoms, did not listen to them, were culturally insensitive, provided incorrect information, and did not engage with or care for them (Read et al., 2021). Contributing to this is often limited time allowed for patient-provider communication and the fragmentation of the patient-provider relationship.
- A lack of culturally competency. Trust in healthcare is even lower among patients of color and other historically marginalized and minority patients. Cultural and linguistic differences can make building trust challenging; and differences in beliefs, values, expectation, and style of expression or behavior can all contribute to distrust.
- Increased access to information. We, as a society, have experienced rapid growth of competing and contradictory information when it comes to both personal and public health. Distrust can arise when this information does not match up with what providers believe or communicate to their patients.
- The imperfections of the industry or institution. These imperfections have become clearer to patients over the years, particularly with the rise of managed care and related financial incentives, conflicts of interest highlighted by the media, and growing perceptions among patients that healthcare operates like any other business.
- Insurance. When a patient faces financial challenges due to insurance coverage, it often hurts their relationship with their provider, regardless of the provider’s culpability. And at a more macro level, healthcare insurance coverage has become a controversial issue on the national stage, and beliefs about the issue can roll into the patient-provider relationship
The (Potential) Solutions
Just as there is no single reason for patient distrust, there is no single solution. There are, however, some steps providers and healthcare organizations can take to create an environment conducive to creating and maintaining trust.
- Trust your patients. Patients need to feel that their concerns are taken seriously and believed by their providers. This is particularly true for patients of color who experience higher levels of distrust from their clinicians. And this is not just a subjective feeling…clinicians’ written notes include more markers of disbelief for Black patients, suggesting bias in their perceptions of credibility (Schleifer & Beach, 2021).
We cannot expect patients to trust clinicians, or the health care system more generally, if they themselves are not trusted - Schleifer & Beach, 2021
- Enhance cultural competency and commit to establishing and supporting an inclusive and diverse workforce and environment. Cultural competency enhances feelings of trust and is a high priority among patients. In fact, in a 2021 survey, nearly half of participants reported they would trade off access to convenient, in-person care, traveling longer distances or having virtual visits, to get a provider who looks like them or who is culturally competent (Read et al., 2021).
- Make trust-building an explicit part of medical education. Trust and relationship building are necessary skills for effective patient care but are not typically the focus of medical education. In addition to building the trust of patients, training should include education that addresses students’ own mistrust of and disbelief of patients so they can work on these biases.
- Prioritize patient-provider relationship building in practice. And make it a priority not just for the provider but for the enter staff. Some key pieces are listed below (Gopal, 2020), and all can be supported by efficient team-based care.
- Focus on shared goals, engage in shared decision-making
Two platforms out there that aim to address the impact of cultural competency and stigma in healthcare are HUED and Anyana Therapy.
- HUED is a platform that connects patients of color with health professionals of color who understand their cultural, physical, and mental needs.
- Anyana Therapy is a mental health platform that matches individuals with licensed professionals who share their unique traits, values, and sensibilities.
- Don’t challenge core beliefs or overwhelm patients with information. This is particularly true in the midst of the COVID-19 pandemic, where providers may be increasingly faced with patient beliefs that contradict their own.
- Meet patients where they are. If a patient tells you they haven’t been taken their medication, refrain from judgement or what might be viewed as reprimanding – patients may not be so honest the next time you ask. Rather, approach with curiosity and compassion.
- Consider the culture within your team and organization. The value of trust must be carried throughout a practice, not just a provider. It should support a judgement-free environment and provide a safe space for patients in all interactions.
- Continuously prevent and mitigate provider burnout. Patient distrust can lead to provider burnout. But the opposite is also true: provider burnout, by negatively impacting patient-provider relationships and interactions, can lead to patient distrust.
Schleifer, D. & Beach, M. (2021). In patients we trust: Why clinicians need to believe and respect patients. Available at https://www.healthaffairs.org/do/10.1377/forefront.20210427.553560/full/
Read, L., Korenda, L., Nelson, H. (2021). Rebuilding trust in health care: What do consumers want – and need – organizations to do? Available at https://www2.deloitte.com/us/en/insights/industry/health-care/trust-in-health-care-system.html
Gopal, S. (2020). How can doctors retain patients’ trust? Available at https://rendia.com/resources/insights/how-can-doctors-retain-patients-trust/