Confidence in doctors and hospitals falls by 31%

CMOs and other healthcare leaders must employ several strategies to rebuild trust, including countering misinformation about who benefits from vaccines.

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

The trust that patients place in doctors and hospitals is a major concern for medical directors and public health officials. If patients do not trust doctors and hospitals, they are less likely to follow their recommendations.

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

“Before the pandemic, many doctors took for granted that people would trust them,” Perlis says. “Unfortunately, because there was so much misinformation and politicization of health care during the pandemic, a lot of the initial trust in doctors and hospitals was squandered. What we’ve realized is that we need to rebuild trust if we’re going to support public health in the future.”

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

“Unfortunately, over the course of the pandemic, especially with the spread of misinformation about COVID and the vaccine, trust declined substantially,” Perlis said. “We weren’t surprised that trust declined, but we were surprised by the magnitude of the decline.”

The research paper is based on survey data collected from more than 440,000 American adults. In addition to the finding that trust in doctors and hospitals fell by 31%, the study, which was published in JAMA Network Openincludes three key results:

• Higher levels of trust were associated with a higher likelihood of being vaccinated against COVID-19 (adjusted odds ratio 4.94) or influenza (adjusted odds ratio 5.09), as well as receiving a COVID-19 booster dose (adjusted odds ratio 3.62).
  
• Characteristics linked to lower trust included being between 25 and 64 years old, being female, having a lower educational level, having lower income, being black and living in a rural area.
  
• When respondents were asked why they had lower levels of trust, reasons cited included financial motives over patient care, poor quality of care and negligence, influence of outside 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. Photograph courtesy of Mass General Brigham.

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

“If your doctor tells you to do something, either directly or through the hospital where you get your care, there’s no reason to follow the recommendations if you don’t trust what they’re telling you about something like vaccination,” Perlis says. “That’s one of the reasons it’s imperative that we rebuild trust.”

According to Perlis, the loss of trust is different for each group.

“Some of them may be more likely to have had bad experiences with health care. Historically, we know that we haven’t necessarily treated all groups equally,” Perlis says. “Unfortunately, public health became politicized during the pandemic, and some of the groups that were associated with less trust were more exposed to the politicization of health care.”

According to Perlis, the reasons for the loss of trust fell into several categories for respondents:

• One of the reasons was bad experiences with their own care or the care of a family member.
  
• There were concerns about conflicts of interest.
  
• People were concerned that doctors or hospitals might have financial motives rather than simply focusing on providing the best care.
  
• There was concern that doctors or hospitals could be influenced by outside entities or agendas.
  
• There was a subset of respondents who had experienced discrimination or bias in their interactions with the health care system.

How to restore trust in doctors and hospitals

According to Perlis, there are several steps CMOs and other healthcare leaders can take to restore trust.

“It’s one thing to say that trust has declined,” Perlis says. “It’s another thing to think about how we can regain trust, which will be necessary for all kinds of public health initiatives, including the next pandemic and anything that involves intervening to improve public health. We absolutely must prioritize rebuilding trust.”

Strategies to restore trust must be developed taking into account the reasons why it has been eroded.

“Strategies to rebuild trust are probably not a one-size-fits-all solution,” says Perlis. “Some of the underlying concerns need to be addressed.”

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

“For example, we have transparency laws that allow people to easily know if their doctor is being paid by someone other than the hospital,” Perlis says.

CMOs and other healthcare leaders need to counter misinformation about who benefits from things like vaccines or drugs.

“It’s important to just clarify who pays for these things and who benefits financially from them,” Perlis said.

For people who have had bad experiences with health care or feel they were not treated well, this is harder to address.

“We need to find ways to reconnect with these people,” Perlis says. “One way to do that is to listen to them. We can have people go see their doctor and find out why they had bad experiences.”

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

“There are many reasons why people get frustrated, such as long wait times to see a doctor,” Perlis said. “We need more outreach and more accessibility.”