Why Might Patients Not Trust Health Systems and Providers?

Daniella Lamas is a critical care physician at Brigham and Women’s Hospital in Boston. She recalls telling the wife of a patient who was dying something she did not want to hear about her husband’s care. The woman told Lamas:

“Why should I believe you? I don’t think that I do.”

The Imperative for Trust

Lamas correctly points out that without trust, it becomes very difficult for people to achieve good health – either as individuals or across a population:

“Our medical system relies on trust – in face-to-face meetings as well as public health bulletins. Distrust can lead doctors to burnout and can encourage avoidable negative outcomes for our patients. This is partly what is driving increasing rates of measles among unvaccinated children, failure to follow recommended cancer screening and refusal to take lifesaving preventive medications. There are no easy solutions here. But if we do not find ways to restore and strengthen trust with our patients, more lives will be lost.”

Systemic Problems

Patients have lost trust in health systems for many reasons. Lamas says that health systems largely do not deserve the blind faith of patients. On top of that, outright cynicism has overtaken reasonable skepticism in public discourse and private sentiment. We are living in an age of low trust.

Especially in obesity care, health systems do more to institutionalize bias that dehumanizes people than it does to to permit actual care for them. Providers cannot spend time listening to patients – yet listening is essential for good obesity care. Health insurance implicitly blames patients for their condition, asking them to prove that they deserve access to care by participating in behavior change programs.

Systemic weight stigma is pervasive in healthcare and makes poor health outcomes more likely for people living with obesity. Indeed, in such a system, why would a person with obesity ever trust healthcare providers?

The Need for Empathetic Care

If we wish to build trust in health systems and providers, empathetic care is essential. Jeremy Howick and Sian Rees explain:

“The limitations of guideline- and evidence-driven care and healthcare’s rising costs, together with the overwhelming evidence that empathic care can improve a wide range of outcomes in diverse patient populations, suggest a new paradigm for medicine is necessary. Empathy-based medicine promises to improve patient outcomes, reduce practitioner burnout and save money.”

Without empathy, there is no care in healthcare.

Click here for Lamas’ excellent essay on trust in healthcare. For further perspective on empathetic care, click here, here, and here.

The Hand of Surgeon Theodor Billroth, detail of sculpture by Kaspar von Zumbusch, photograph by Hubertl, licensed under CC BY-SA 4.0

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April 28, 2024