Mistrust in healthcare professionals has risen

Mistrust in the medical field, especially in the US, has been rising within the general public—having a father that is a doctor makes sure I hear about it all. Beyond the undermining and general skepticism around science, doctors and healthcare professionals are finding it hard to have their advice taken seriously. The bottom line is that they spent over a decade in higher education learning about what people think they fully understand after one quick Google search. 

The COVID pandemic was an example of huge widespread mistrust in medical professionals. People began to believe misinformation by those without degrees over those with them. Gregory Morgan, professor of history and philosophy of biology and applied ethics at Stevens Institute of Technology said that he was “disheartened during COVID.” He also is worried about public compliance if there were to be another pandemic in the future. It’s not just COVID—mistrust of medical advice has risen, with one study showing that 55% of patients reported a negative experience where they lost trust in a health care provider.

Many groups have mistrust due to racial mistreatment tracing back decades. Racial injustice and inequity unfortunately exists in most areas, but is heavily present in the medical field. In the past, Black Americans were the subjects of medical experiments and forced treatment testing. Even today many of their concerns are dismissed and not taken seriously. These deep rooted traumas and dismissals can affect them for generations. My own uncle was extremely hesitant to get the COVID vaccine due to him being Black—he was not only concerned that it would affect him differently, but that the doctor was testing some kind of treatment on him, using him as a guinea pig. He was scared of something that many white people, including myself, got without a second thought. I never felt scared that they weren’t injecting me with what they said they were. My uncle and the Black community are not alone in their fears—the LBGTQ+ community is included in groups most likely to distrust their healthcare providers, most likely largely in part to being mistreated and judged during the HIV/AIDS epidemic. Women are also a group that is distrustful, many comments of pain not being legitimized or symptoms commonly assumed to be caused by periods, which is not always the case. Many groups are predisposed to be distrustful, and with assurance and taking concerns seriously, healthcare providers can gain back some trust from these people.

These racial inequalities seep into every aspect of life. Low income communities are likely to have higher diversity levels. These towns are also likely to have underfunded schools, where children can’t get a decent education. They can’t afford tutors, so they don’t get high grades. They then can’t get into good colleges or don’t go to college at all because they can’t afford it. And the cycle continues. These groups of people are more likely to get the short end of the stick in healthcare and have poorer health without even considering the quality of food they are able to afford or the environmental factors of their neighborhoods. All this is to say that they are the ones that need good healthcare providers, but can only afford poor ones. They can’t pay for higher deductibles or better insurance or life-saving procedures that are needed due to predisposed conditions. The doctors they can afford are likely to not be good quality. Those with lower education levels may not recognize when they are being taken advantage of. They may not be able to afford to get a second opinion, or have friends or family members in the field to ask opinions of. They have to rely on their lower-priced providers and what they are saying.

Clearly much of the skepticism and mistrust is justified even outside of racial bias—we have all heard stories of people being overcharged, only having unnecessary fees taken off of medical costs only after they ask for an itemized bill, exposing the things they were charged for but didn’t receive. Lack of transparency has not been helpful in calming worried people, whether that be wondering if they are being charged for these hidden things, or if their doctor has some other incentive for suggesting certain care. However, starting in 2014 the federally mandated program called the Open Payment database was created, and can be used to search payments made by drug and device companies to physicians and hospitals. All payments are required to be stated and logged, making sure that transparency is accessible for those receiving care. There is also the Physician Payments Sunshine Act which was created in 2010 that “requires that detailed information about payment and other payments of value worth over ten dollars from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.” Programs like these can help not only to show patients if their doctor has ulterior motives, but also make many who were only suggesting things for the money reconsider. With things like these we can ensure that when a doctor recommends something to the patients (even if they are being paid), they trust that it is the best option because of the full transparency.

A lot of information is thrown at us and, when in a desperate and vulnerable state, we may grasp at straws. The United States and New Zealand are the only two countries that allow drug manufacturers to market prescription drugs directly to the public. However, New Zealand has universal healthcare. That means that the US is the only place in the world without universal healthcare that advertises directly to citizens. The ads often show happy people, seemingly so glad they no longer bear the pain of their conditions. They are advertising a promise that is not universal to everyone—doctors know the full story of the patient. My father, Franklin Loria, is a physician, and I asked him how he feels about the ads: “I think it is awful. Patients do not have the education, knowledge or experience to consider the pros and cons of pharmaceutical chemicals.” We have to trust that the doctors know and are doing what’s best for us as patients, and while that is extremely difficult, it’s a two way street.

Many people hear stories or see these ads for prescription drugs and come into the doctor’s office thinking they know all about it from a one minute ad. But many fail to recognize that the doctor will know more about that drug—they end up attempting to undermine their expertise. Dr. Loria finds it frustrating: “patients think that if they google the symptoms and ChatGPT diagnoses them, they can be a doctor. It’s not like picking from a multiple choice list. What I provide, a computer can not.” These professionals have gone to school to provide care to the best of their abilities. They have studied how to take everything into account and look at probability for all options. Morgan states that “the general public has a hard time comprehending probabilities and balancing the risks with those probabilities.” Doctor’s went to school for this, and the public has a hard time accepting that. They do make mistakes or do things that may seem excessive, but I personally trust that they are doing what they truly believe is the right thing. I believe the benefits of “excessive screening” or multitudes of tests (finding something that could harm me) outweigh the risks. Weighing the benefits and risks is personal but also medical, and only the doctor and the patient know the full story and can make that decision together. Moving forward is important, because being stuck will get patients nowhere. Skepticism is justified, but trust in medical professionals and their history and education is essential—you should always have less than 100% confidence but not everything is zero.

Cited:

“CMS Open Payments.” openpaymentsdata.cms.gov. https://openpaymentsdata.cms.gov/.

“Franklin Loria, MD.” MDVIP. https://www.mdvip.com/doctors/franklinloriamd.

“Gregory Morgan.” Stevens Institute of Technology. https://www.stevens.edu/profile/gmorgan.

“How Your Income Affects Your Health.” WebMD. https://www.webmd.com/health-insurance/features/how-income-affects-health.

“In Brief: Benefits and Risks of Screening Tests.” InformedHealth.org [Internet]., December 17, 2019. https://www.ncbi.nlm.nih.gov/books/NBK279418/.

“Marginalized Communities Likely to Distrust Healthcare System, Polling Finds.” News, February 7, 2023. https://www.hsph.harvard.edu/news/hsph-in-the-news/marginalized-communities-likely-to-distrust-healthcare-system-polling-finds/.

“Medical Mistrust: One Obstacle on the Path to Health Equity.” Medical Mistrust’s Role in Health Equity | RTI Health Advance, June 14, 2022. https://healthcare.rti.org/insights/medical-mistrust-and-health-equity.

“New Zealand Healthcare System.” International Citizens Insurance, July 9, 2024. https://www.internationalinsurance.com/health/systems/new-zealand.php#:~:text=New%20Zealand%27s%20healthcare%20system%20is,law%20universal%20and%20free%20healthcare.

“Physician Payments Sunshine Act.” AdvaMed, November 10, 2022. https://www.advamed.org/our-work/policy-areas/legal/physician-payments-sunshine-act/.

Prescription drug advertising - from approval to your Screen. https://www.floridahealth.gov/_documents/PHIC_drug-advert-factsheet4.pdf.

“Understanding and Ameliorating Medical Mistrust among Black Americans.” Commonwealth Fund, January 14, 2021. https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans.