DO YOU STILL TRUST YOUR DOCTOR?

If you’ve gone to the same doctor for a long time, you probably do trust him/her. You’ve consulted your doctor for many years and had enough doctor-patient encounters that your relationship has been tested and proven to be sound. Unfortunately, younger generations of Americans don’t have that same feeling. An article in the January issue of Medical Economics talks about the loss of physician trust and the reasons for it. 

The article cites that 74% of baby-boomers have a “mostly positive” view of medical doctors and trust the health care system “some” or “a lot.” However, among younger folks born between the 1990’s and 2010’s, so-called Generation Z, only 44% trust physicians and 56% do not. That’s very low. 

I don’t know if the authors of this article were/are physicians or not, but I’m going to assume they aren’t. They presented four reasons for the decline in trust derived from factors interpreted from their perspective. These four reasons are:

   1. Most doctors are employed by large hospital systems that require them to “see an average

         of eight patients in 30 minutes.” The doctor and patient barely have time to say hello to

         one another let alone develop trust in 4 minutes.

   2. Lack of ready availability of wellness information and ratings figures on providers. 

   3. The skyrocketing cost of health care.

   4. White physicians, who do not believe they are prejudiced, “typically demonstrate

         unconscious implicit negative racial attitudes and stereotypes.”

Really? Here we have an article in the major, business-related, non-scientific journal read by millions of practicing physicians that says white physicians are inherently racist, and others are motivated by greed, don’t educate their patients, and charge too much! WOW! They forgot to say we overprescribe opioids, don’t return calls, and make prescribing errors all the time. Oh, yes, and people die unnecessarily due to our terrible negligence. If I had seen this letter sooner, I would have written a letter-to-the-editor in rebuttal. In fact, I still think I will!

I think it’s possible this article was written by someone in a ivory tower; not by a physician, nurse, or patient. Why do I say that? Because the reasons presented are nowhere near the real reasons for lost trust. They parrot the current narrative that every problem in America has a racial undertone and that physician greed has increased costs and decreased quality of care. 

I have a different list of reasons that begins with the assertion that medical bureaucracies, primarily Medicare and managed care organizations, have so strangled, restricted, and debased physicians that they no longer care. The result is a change in physician attitude that affects the interaction with patients. Many physicians are unhappy with the state of medicine, and that discontent is expressed in their indifferent, short-tempered, impatient response to patients.

First, I’ll respond to the four reasons given in the article. It’s a very short retort: “BUNK!”    

     The idea that doctors are forced to see 8 patients every 30 minutes must be a typo. There

        is no physician who could do that so that reason is ludicrous.

     The idea that patients can’t readily access physician healthgrades and wellness information

        is ridiculous, too. Ever heard of the internet?

     High costs anger patients, true, but that starts with insurance deductibles. They have to be 

       ridiculously high so that premiums are affordable. Co-pays are an irritation, too, as is

       health insurance that doesn’t pay 100%. These are third party payer issues, not physician

       trust problems. Anti-physician media bias that portrays physicians as greedy and “in it

       only for the money” affects trust, too.

     The racial bias comment is way off base. Sure, there are some bad apples; that’s human

       nature. From the start, medical schools emphasize a non-judgemental attitude, and that all

       patients are to be treated the same, regardless of our many differences. The inference that

       white physicians are unconsciously inherently biased is racist itself. 

I think there are several more realistic reasons for lack of trust. Physicians have ruined their image, reduced their prestige, and lost trust because they are rude to patients.  They don’t listen, they interrupt when a patient is trying to give an explanation, are impatient with patients, and don’t show courtesy and a caring attitude. They aren’t always honest with patients giving false hope, exaggerating, or minimizing situations. Patients remember what they’re told and lose trust when the situation plays out differently. They blame symptoms on the patients imagination or old age and don’t give them credit for having intelligence or common sense. They belittle patients’ opinions. It comes down to mutual respect. If the physician shows a caring attitude, listens, and is patient, trust will be established. 

The younger generations of Americans are now being cared for largely by “doc-in-the-box” urgent care centers or Emergency rooms. They don’t have a family doctor. Patients see someone different every time. Continuity of care becomes fragmented, and no one follows up on the care of the patient. Results of tests are not reported in a timely manner or not at all. This has come about because of the demise of the local neighborhood family doctor concept. The local doctor has retired, become an employee of a health care company, or died. He/she is no longer there to see to all your health needs. Instead, you see a different doctor, or nurse practitioner, every visit, and rapport and trust are never established. 

TV programs that tell scenarios of physician fraud, abuse, corruption, and incompetence have also destroyed trust in the profession. Doctors are portrayed as greedy, unethical, and conniving and people begin to think all doctors are like that. “Mystery Diagnosis” and “American Greed” are two programs that repeatedly report on missed or incorrect diagnoses or money-making schemes that bilk Medicare and health insurers out of millions. Patients are negatively influenced by these programs, no doubt. 

My reasons for lack of trust stem from comments heard from my patients and encounters my wife or I have had personally. First hand experience is telling. If rude behavior is even directed to doctors or their spouses, the profession has a big problem. I think it comes down to the heart of the individual; not the beating heart, but the inner soul, conscience, and personality of the doctor. Care, compassion, and patience come easily for some but grudgingly for others. We need more of the former to improve trust. When I hear it stated by an influential person in a public forum, “I don’t trust doctors!” the medical profession has a problem and needs to wake up. 

Reference: “Lost of trust in physicians” Medical Economics 2022 Jan:23.

Addendum: I recently consulted a physician who fits all the criteria for trusting his word. I told him, if I were still in practice, he would get all my referrals. The reasons? He listened, he was not rushed or in a hurry, he explained things clearly, and he did not make me feel like an imbecile. He patiently listened to my comments and asked if I had any questions. He made me feel like my problem was just as important to him as it was to me. If all doctors had his attitude and demeanor, the level of trust in doctors would be closer to 100%.