How Healthcare Can Solve Its Patient Trust Problem

January 05, 2023 - Healthcare has trust issues—patient trust issues, that is. After a whirlwind three years, the medical industry is staring down a population that is exhausted by pandemic precautions, coming to terms with decades of mistreatment of Black and Brown bodies, and questioning the advice of their clinicians, ranging from whether masks are necessary to full-blown vaccine hesitancy.

In the mainstream press, healthcare and public health has been politicized, and the question of patient trust has become a blue and red issue. But like many healthcare professionals, Gregory Makoul, PhD,  chief transformation officer for patient experience consulting firm NRC Health, knows that patient trust runs deeper than party politics.

“There is a pervasive narrative that people of certain political persuasions do or don't have trust in authority, or in science,” Makoul said in an interview with PatientEngagementHIT.

Just look at polls measuring vaccine access and hesitancy. Those polls are broken down by red and blue voters, just like surveys measuring acceptance of certain pandemic precautions like masking and social distancing.

While those polls can be enlightening, Makoul said what happens inside the clinic and exam room is a better predictor of whether patients trust their providers, and he has the figures to prove it.

NRC Health surveyed 680,000 healthcare consumers in April 2022 about their trust in their individual clinicians and the healthcare industry at large and found that party politics makes very little difference. The researchers combined NRC Health’s patient experience data with county-level voting from the 2020 presidential election and Claritas demographic data for 3029 of the 3243 US counties or county equivalents.

Of the 20 counties with folks reporting the lowest levels of trust, NRC Health found that 17 voted mostly red while three voted mostly blue. Although those figures confirmed that “pervasive narrative” Makoul mentioned, he noted that similar results shook out when looking at communities reporting high levels of trust.

Of the 20 counties reporting the highest levels of trust, 17 were mostly red and three voted mostly blue. In other words, political party doesn’t matter much when it comes to patient trust.

“Our research is showing that it’s more important to think about human understanding than about political persuasion when it comes to trust in individual providers,” Makoul said. “It's not the red or blue political ecosystem that's determining trust in individual providers, it’s the relationship with individual providers. What happens in the clinical encounter? Does the provider treat the patient as a unique person?”

Makoul said bringing human understanding back into healthcare will be essential for closing any patient trust gaps in the clinic and beyond.

Building patient trust in the exam room

Although patient trust in hospitals and health systems is getting better, it still hovers below 50 percent—it rose from 20 percent in April 2020 to around 35 percent in April 2022. There’s room for trust to grow, plus it’s healthcare providers who need to communicate on an individual level with folks who don’t trust them or public health advisors.

Trust might be getting better in clinical spaces, but it’s such an important form of social currency that it’s still critical for clinicians to better understand how to build it. According to Makoul, that starts with empathy and human understanding.

Take, for example, the patient who distrusts a vaccine because she has done her own research online. That’s not a new phenomenon, Makoul said, with the rise in online search and Dr. Google making its way into the exam room. In 2018, Merck Manuals reported that more than half of clinicians are meeting with patients who bring in outside research, and 97 percent of them said patients are accessing misinformation.

That makes the patient visit trickier, Makoul acknowledged, but it’s important for the provider to be empathic and remember that patients are just scared. That’s why they are consulting outside sources in the first place.

That fear heightens everything else during the clinical encounter and means these opinions might be very tightly held, Makoul mentioned.

“It is important for the doctor or other member of the clinical team to try to put things in perspective for patients,” he stated. “I don't think that saying, ‘You're wrong,’ is a winning strategy, but saying, ‘You've got to think about the source of the information. Please recognize that I respect your personal opinion, but I'm going to tell you what I know and what I think.’”

“The key to achieving human understanding in everyday practice is to remember that clinicians are experts on clinical medicine, patients are experts on their lives and what we're trying to generate is a meeting between experts,” he added.

Clinicians can use human understanding to build trust beyond addressing medical misinformation. Studies have shown that patient trust erodes when patients have a bad interpersonal encounter, like if their clinician was dismissive of their needs or did not acknowledge their circumstances.

“Human understanding – treating a patient as a unique person – is a key to real health equity,” Makoul explained.

“This means taking into account what the patient is up against as well as listening to what the patient is trying to achieve before coming up with a plan of care. At root, it means taking care of you as you, not somebody who looks like you or sounds like you or is in your group or segment, but you. And doing that for every patient is a pretty direct line to achieving equity.”

Building public trust in government healthcare voices

Trust is getting better in clinical spaces, but things are dismal for other healthcare or healthcare-adjacent entities, like the federal government and public health agencies.

Trust in the federal government to handle the pandemic was at 10.6 percent in April 2020 and fell below 10 percent until May 2022, when it rose to 13.2 percent. Trust in state government dropped from 13.8 percent to 7.2 percent, and trust in local government has been around 5 percent throughout the entire pandemic.

Other groups are finding the same. In April 2021, the RAND Corporation found that trust in the CDC dropped 10 percent during the first parts of the COVID-19 pandemic. A July 2019 Harris Poll found that trust in public health fell from a pre-pandemic 83 percent to 78 percent. Both groups posited that this will open the door for medical misinformation.

“The public-health messages were extremely mixed and it was very difficult for people to get a handle on ‘What are you asking me to do and why are you asking me to do it?’” Makoul said, granting insight into those flailing numbers. “It didn't help to have important people, whether in the government or the public health system, not speaking the same language.”

The concept of human understanding doesn’t need to be unique to the clinical space, Makoul recommended. Public health agencies, from the federal all the way down to the local level, should work to truly understand their audience, their needs, and their concerns, to craft more empathic messaging.

“When it comes to planning public health messages, starting with questions like ‘Where are the people we are trying to reach in terms of their ability to hear us?’ and ‘What are they feeling about what they've heard before?’ is as important as determining the message content and source,” he advised. “A lot of people hold views very dearly and it can be threatening to say, ‘It's just wrong.’”