• Adam Tabriz, MD

Are American Doctors On The Verge Of Losing Patient Trust?

The Physician-Patient Relationship Is The Beginning And Continuum Of Patient Trust.

Illumination initially published this article on Medium!


Photo by Günter Valda on Unsplash

The doctor-patient relationship is one of the most sheltered and privileged connections any institution can endure. It is built on trust, yet unfortunately, it is never invariably devoid of flaws. That is not because it knowingly tumbles through the ethical and legal dilemma, but often is the upshot of poor rapport between the two parties, the physician and the patient.

Good old days, when patients reached out to a doctor, they did so based on that initial direct rapport built on and before their initial encounter. But, today, we witness the shift of scenario so that it is often an intermediary that negotiates which physician connects with which patient, how, under what condition, when, and vice versa.

The most fundamental element of every doctor-patient relationship is “trust.”

Trust is about someone believing in the reliability, truth, or ability of the physician they reach out to care for them. Trust of the patient in a physician ought to be on a firm belief in the doctor's reliability and truth. But, a patient and the doctor can only achieve that through good mutual transparency and the system around them.

Nevertheless, Today The Patient's Trust In Doctors And Healthcare, In General, Is Under Scrutiny.

A survey conducted by the American Board of Internal Medicine (ABIM) Foundation in May 2021 highlighted three significant findings:

  1. Physician trust decreased among patients during the COVID-19 pandemic.

  2. Despite the lower patient trust in physicians, their faith in physicians remains higher than overall healthcare.

  3. Physicians do not invariably perform trust-building behaviors.

Based on a report published in the January 2022 edition of Medical Economics, the decline in patient trust in physicians is not new. Trust in physicians has had a downward trend for over a decade.

According to a 2017 Sermo survey, 87% of doctors believe patients trust them less than ever before. The younger generation and millennials' inclination to such a disposition is more pronounced in the United States.

The publication's author points out that the Americans' steady flop of confidence in all institutions is a big player in such a distrust. That is something they claim commenced with the Vietnam War and Watergate. Therefore, amid recent corporatization of medical practice that forced primary care physicians to work for large hospital systems limited the time they can spend with patients.

There is validity for why the young generation chooses not to trust the healthcare system and their physician. Yet, if I must select one reason from many sundry reasons why doctors are losing patient trust is this: "Tyranny of the Intermediary." That includes large Corporations, politicians, and, more specifically, the insurance industry.

The loss of trust is the upshot of the indiscriminate introduction of value-based payment model-driven bureaucracy and administrative mandates beyond transparency coupled with fictitious quality and key performance indicators that are one-size-fits-all. And that size only fits the deep pockets of the corporate cartel.

The article also highlights one of the impacts of the "Tyranny of the Intermediaries."

The Quote is as follows:

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

Yet again, there is only one way to describe this problem:

Primary care is the bureaucratic concept driven by managed care system to ditch the burden of cheap labor on a few medical specialties, including Family Medicine and Internal Medicine, thus pressing them to work more for relatively lesser return. So, primary care is not and will never be a medical specialty.

Some also believe access to the ocean of information on the internet is another reason the young generation of patients elect not to trust them, merely because they are less inclined to lean on a physician's diagnosis treatment plan unconditionally.

Again, I must underscore that the physicians must also grasp that the "Utilitarian" pinnacle of medical practice is outdated and that they must see patients as partners in their medical care rather than the total adherents to their clinical judgment.

One can explain the need for physician practice reform without 3rd party influence based on another survey outlined in the Medical Economics Journal of 2016, where most surveyed physicians stated that their practices were increasingly encountering angry patients. That was more than the prior years, and 56% of them were presumably related to financial issues.

It is not formidable to imagine the patient's frustration, given the overwhelming influence the insurance industry has over physician payment schemes and the cost of healthcare.

Indeed, other factors may influence patient trust in the physicians, including negative racial profiling attitudes and racial and ethnic disparities in health care.

Stereotyping, preconceptions, and fate on the part of physicians and medical staff can all contribute to inequity in healthcare. Nevertheless, we would not have had this conversation if we had a way to match physicians and patients exclusively based on individual profiles and expectations. That is in contrast to the corporate-driven profiles such as type of coverage, health plan, location, and even performance by 3rd party criteria.

According to a survey, patients would conceivably select their physician based on their insurance coverage, comfort, and referral from a friend or family member if given options.

“To reestablish public trust in the medical profession we must retain their confidence in the context of individual doctor-patient relationship” — Adam Tabriz, MD

The Bottomline Of The Patient Trust Issue

Patients' trust in healthcare is at its all-time low. But, it is salvageable.

The Physician-Patient relationship is the beginning and continuum of patient trust.

In every doctor-patient relationship, each patient visit is a step-by-step process that resembles the bringing down of the wall between a physician and the patient brick by brick. The wall can be in place for many reasons, as described before.

We build and maintain trust, and the key to emphatic trust entails better communication, collaboration, and interpersonal aptitudes. Every physician must make efforts to construct patient trust, but such skill is continually challenged and exploited by the intermediaries' bureaucracy, monopoly, and tyranny.

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