Loss of confidence in doctors

Editor’s Note: The past year has been one of the most difficult on record for American physicians. After the lockdowns and the telehealth wave of 2020, the year 2021 has been a strange one. While things have returned to “normal” as most practices have returned to seeing patients in person, the COVID-19 pandemic and its challenges remain. Like every year, Medical Economics® questioned our audience to find out what the major challenges were. By far the primary response was “administrative burdens” including staffing, pre-clearances, and electronic health records (EHRs). We’ve decided to take a closer look at what these burdens entail, to help physicians prepare for whatever challenges 2022 will bring. Here is number five.

Doctors often complain that, like the late comedian Rodney Dangerfield, they “get no respect.” But when it comes to respect and trust, medicine and its practitioners fare better than many other aspects of American society.

In a 2019 Pew Research Center survey, 74% of people said they had a “mostly positive” opinion of doctors. In contrast, only 35% said they had “a great deal of confidence” or a “fair amount” of confidence that elected officials would act in the best interest of the public, and 46% said the same of business leaders.

Yet trust in doctors has declined. In a 2017 Sermo survey, 87% of doctors said patients trusted them less than they did a decade earlier.

The trend is particularly pronounced among young Americans. A Morning Consult survey from November 2021 found that 74% of baby boomers do ‘a part’ or ‘a lot’ of the healthcare system, but that number drops to 44% among Gen Z – those born in the late 1990s. 1990s and early 2010s.

What caused this erosion of trust in doctors and medicine in general? According to experts, this partly reflects the loss of American confidence in all institutions that began with the Vietnam War and Watergate. But there are also reasons specific to medicine. Perhaps most important of these is the limited time that primary care physicians working for large hospital systems – now the majority – can spend with patients.

Bioethicist Stephen Post, Ph.D., said Medical economics® in 2018 that many hospital systems, where the majority of primary care physicians now practice, require physicians to see an average of eight patients in 30 minutes. “With this pace, it’s extremely difficult to build trust and create meaningful relationships,” Post said. To make the problem worse, patients often do not stay with the same doctor long enough to build trust; doctors leave (or are excluded) from insurance networks, or employers change insurance companies in search of lower costs.

Another factor contributing to the erosion of trust is the immediate availability of medical and wellness information, as well as information and assessments for healthcare providers, on the internet and through social media. A 2015 Medical economics® noted that about 5% of all searches on Google were related to health and the percentage has almost certainly increased since then. “We have seen an explosion in the type of information ordinary people can access about their own health and from sources such as medical journals and clinical trial results,” said the author and engagement consultant. of patients Jan Oldenburg. Medical economics® in 2019.

Oldenburg and other experts argue that while this “patient empowerment” enables patients to become more actively involved in their health and well-being, it also means that they are less likely to have significant confidence in the diagnosis of disease. ‘a doctor or follow a treatment plan that patients before the Internet.

Patients’ confidence in their health care providers is further weakened by soaring costs of care. Although doctors are not primarily responsible for the problem, they are often the ones who suffer the most anger from patients. Eighty-seven percent of physicians responding to a 2016 survey Medical economics® reported that their practices were seeing more angry patients than a year or two ago, and 56% said financial problems were the number one cause of patient anger. In some patients, this anger takes the form of believing that their doctor is recommending unnecessary tests or procedures to make more money.

Of course, for large groups within American society – particularly people of color – distrust of physicians and the health care system has long been and frequently justified. A 2003 Institute of Medicine report on racial and ethnic disparities in health care found evidence that “stereotypes, prejudices and uncertainty on the part of health care providers can all contribute to a unequal treatment ”. In addition, according to the report, white clinicians who do not believe they are prejudiced “generally demonstrate unconscious implicit negative racial attitudes and stereotypes.” Many public health experts believe this mistrust among members of the black and Hispanic communities contributed to their initial reluctance to be vaccinated against COVID-19 compared to whites (although the gap has since narrowed).

Building – or rebuilding – trust with patients is not easy, especially given the time and financial constraints most physicians face. Nevertheless, it is possible. The process begins by maximizing the time available to be spent with patients, for example by delegating to staff members tasks that reduce the time spent on doctor-patient interactions. Then use the time to listen. “Let patients talk about the personal aspects of their illness, then add an affirmative comment like ‘This must be very difficult,'” Post advises.

Dhruv Khullar, MD, MPP, New York City internist and author of a New York Times article on trust, reminds doctors that they can no longer expect automatic trust, but “if we work hard to demonstrate that we are trustworthy, patients will trust us over time.”

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