Coronavirus pandemic has eroded physician trust in several areas, survey finds

By Christopher Cheney

The coronavirus pandemic decreased physician trust in several healthcare institutions and sectors, according to a recent national survey.

Physicians are essential players in the healthcare system. When physicians lack trust in institutions, sectors, and colleagues, it erodes healthcare’s fundamental grounding in a series of human relationships.

The recent national survey, which was conducted by NORC at the University of Chicago for the Philadelphia-based ABIM Foundation, is based on information collected from 600 physicians nationwide.

The national survey features several key data points on how the pandemic has impacted physician trust in the following institutions, sectors, and colleagues:

• The healthcare system as a whole: increased trust (17%), decreased trust (30%), trust remained the same (53%)
• Hospitals: increased trust (23%), decreased trust (19%), trust remained the same (58%)
• Healthcare organization leadership: increased trust (18%), decreased trust (30%), trust remained the same (52%)
• Pharmaceutical companies: increased trust (21%), decreased trust (13%), trust remained the same (66%)
• Health insurance companies: increased trust (6%), decreased trust (31%), trust remained the same (63%)

The erosion of physician trust during the pandemic is a serious problem, Richard Baron, MD, president and CEO of the American Board of Internal Medicine and the ABIM Foundation, told HealthLeaders.

“It is a severe problem, but it is equally well-framed as an opportunity that if we focus on trust, we can make things a lot better. That is the core effort that we are undertaking—we are saying that getting organizations to focus on getting trustworthy is something that will help them be successful as organizations,” he said.

The pandemic decreased physician trust in healthcare leaders, Baron said.

“The pandemic was a stress test for the healthcare system in many ways, and institutions faced all kinds of challenges in terms of getting personal protective equipment for doctors, managing the major financial stresses associated with the pandemic, and other difficulties. How people navigated those challenges as leaders was something that physicians paid a lot of attention to. If leaders did not supply adequate personal protective equipment and expected doctors to show up, it breached trust. Doctors remember those circumstances.”

Healthcare leaders can pursue several strategies to restore physician trust that has been decreased during the pandemic, he said. “Healthcare leaders cannot take the trust of physicians for granted. They need to strategize as leaders in an intentional way on how they can rebuild trust. There are several strategies available to them. Transparency is a trust-building strategy. Engagement is a trust-building strategy. Sitting down with physicians when decisions need to be made is a trust-building strategy. Admitting mistakes is a trust-building strategy.”

Other dimensions of physician trust

The national survey also measured broader measures of physician trust independent of the pandemic. These measures included physician trust in the following areas:

• Health insurance companies: completely trust (1%), somewhat trust (19%),  neither trust or distrust (23%), slightly distrust (36%), completely distrust (22%)
• Other doctors within your practice: completely trust (63%), somewhat trust (31%), neither trust or distrust (5%), slightly distrust (1%), completely distrust (0%)
• Other doctors outside your practice: completely trust (20%), somewhat trust (66%), neither trust or distrust (11%), slightly distrust (4%), completely distrust (0%)

The relatively high level of physician mistrust of insurance companies is concerning, Baron said. “Insurers understand that the stronger their collaboration with physicians the better their relationships are with their beneficiaries and their corporate customers. No human resources benefits manager wants to hear complaints from employees about physicians disparaging insurance companies. So, the relationship between physicians and insurers is important and needs sustaining.”

Insurance companies can take several actions to gain a higher degree of trust among physicians, he said.

“It requires relationship building, engagement, transparency, and honesty. Insurers need to acknowledge or admit mistakes, they need to explain policies in ways that are accessible, and they need to create effective working processes. If an insurer has processes that are full of bureaucratic hurdles and doctors are stumbling over poorly designed systems, that does not build trust. If you give doctors a clear pathway to get through whatever you want them to get through, that can be a trust-building strategy.”

The relatively high level of physician mistrust of doctors outside their medical practices also is concerning, Baron said. “It is a problem. For example, when people look at root causes of malpractice cases, it is common for litigants to hear a clinician say terrible things about the care provided by another clinician. The idea of a physician not trusting another physician puts everyone in a difficult position. The patient does not know which physician to believe. It puts the physicians in a difficult position because it leads to litigation and anxiety.”

There are ways to build trust between physicians and clinicians outside of their practices, he said. “It is a lot about relationship building, responsiveness, and reliability. Every interaction is an opportunity to build trust and trust gets built by a set of behaviors—by empathy, by connection, by competence, and by compassion. Those behaviors either come across in a consulting letter or they don’t. Those behaviors either come across in a phone call or they don’t.”

Consulting physicians need to be intentional in their efforts to establish trusting relationships with referring clinicians, Baron said. “The consultant who thinks that what they are responsible for is knowing the literature in their discipline and as long as they get that right their referring doctors will love them are missing the point. A physician expects a consultant to be competent and current, but trust is not going to come from just your competency and whether you are current with the literature. Trust comes from a real effort to create a relationship.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders. This story first ran on HealthLeaders Media.