Rebuilding Trust in Healthcare Starts with the People and Communities We Serve.

Trust is central to any relationship, especially in healthcare. In fact, trust is crucial between any service provider and consumer. Without trust, service can be impossible to supply. If I don’t trust that the mechanic will fix my car, I won’t take it to the shop when it is broken. It’s similar in health care: Trust is at the core of our ability to improve health in our communities, and trust is running low.

A 2023 Gallup poll shows that only about 33% of people in the U.S. have “a great deal” or “quite a lot” of trust in the health system. That dwindling number continues a downward trend. 

Of course, trust must be earned through the actions of individuals and health systems. Trust in the expertise and ethics of scientists, researchers, and medical professionals has led to incredible advances. Modern medicine has extended the human life expectancy from 47 years in 1900 to 77.5 years by 2022. This is due in part to generations of effort to:

• Control and prevent previously fatal infectious disease

• Develop treatments and technologies that have lowered mortality rates

• Improve quality of life by better managing chronic conditions such as diabetes, and acute conditions like heart attacks

When trust in our work erodes, our ability to care for our neighbors suffers too. 

Therefore, the question we must address is why society has lost trust in healthcare and how can  we rebuild that trust? I contend that academic health systems are well positioned to re-build trust by truly partnering with patients to collectively advance everyone’s health. How can we do this? 

Reinventing the patient-provider relationship.

On a recent visit to a national park, I became friendly with a fellow traveler. After sharing our professional journeys, I was surprised that he responded with “I never met a scientist before.”  It reminded me that science and researchers are far removed from most people’s daily life. A 2021 survey found that 72% of people in the U.S. couldn’t name a living scientist—and that’s a 7% improvement from 2017. In the same survey, more than half of survey participants could not name a medical or health research organization.

Just as science and research are further removed from most people’s experience, our society’s relationship with medical experts and expertise has dramatically changed over time.

Missing the personal touch.

It wasn’t all that long ago that doctors were viewed as benevolent authority figures who “know best.”

Millions of U.S. households tuned their television sets to programs like Dr. Kildare, Marcus Welby, M.D., and M.A.S.H. Throughout the 1960s and 70s, we watched these kindly practitioners bring a wealth of experience, knowledge, compassion, and training to their patients’ bedside.

Like viewers, these patients did not have the expertise or information their providers had accumulated. They trusted their doctors to guide them back to health. But a lot has changed since then. 

Modern medicine has made incredible advances, but this has resulted in many more specialists and more fragmented care. House calls are less common and primary care physicians rarely have the same personal relationship with their patients today as in the past. Not to mention, the information providers once spent a lifetime gathering through their studies and medical practice, is now available on demand on a device that fits inside anyone’s pocket! Rather than trusting and relying on a kind, caring sole who is the expert, we are often involved in a transaction with a clinician we don’t know, who provides information we already have access to, without the context of how that information is informed from research that can be far removed from our lives. No wonder trust has eroded so much!

The work to restore and reinvigorate a trusting relationship between our communities and our health systems will only happen if we build the bridge from the academicians who create new medical knowledge through the clinicians who use it to care for people, and to those receiving the care. An academic health system, which lives at the crossroads of academia and real-world medicine and is embedded within the community, is best positioned to build those bridges. This will take meaningful, heartfelt conversations in the boardroom and one-on-one in the clinic, our neighborhoods, restaurants, and our patients’ homes. It will mean meeting the patient where they are, listening to their questions and concerns, and sharing information transparently and with goodwill.

MedStar Health is a broad, diverse academic health system. Through our more than 300 sites of care, we are embedded in the communities we serve. Our research-based initiatives and partnerships across MedStar Health Research Institute enable us to partner with our patients to identify and investigate important questions that directly impact community health.

Doctors as partners, not authorities.

The internet has fundamentally changed the relationship society and individuals have with the healthcare system. We no longer need to rely on experts for the evidence-based information—it’s at our fingertips. Instead, we now rely on experts for their judgment. We ask doctors to help us integrate the information, to understand what applies to us, and to chart a course for action. 

Sometimes, the provider’s goal to cure disease or prolong life may conflict with a patient’s goals for improved quality of life. In these instances, mismatches can lead to resentment that “elite” physicians are imposing their values where they’re unwelcome.

Instead, providers must do the hard work of truly listening to patients, and many do. This means engaging with the patient’s perspective and spending time working toward truly shared decisions that help accomplish the patient’s real-life goals. 

Getting in front of the people.

We know patients can be inconvenienced and frustrated by how healthcare in the country works, from costs to scheduling difficulties to long waits. Messages of skepticism about scientific concepts are amplified by social media and government officials, adding to our challenge.

To achieve our goals of advancing health in our communities, we partner with people and organizations throughout our region to develop and activate programs that make a difference. This real-world work helps us restore trust, one person at a time.

Related reading: How Research Can Drive Improved Healthcare Safety and Equity When Using AI.

How academic health systems can help.

An academic health system like MedStar Health is uniquely positioned to help rebuild trust. Unlike many hospitals and academic medical systems, our emphasis is on health and wellbeing, not just diagnosis and treatment. 

That wider lens enables our health experts to partner with community organizations to address challenges such as social determinants of health (SDOH). These are factors outside of the hospital that can have a significant impact on health, and include things like economic stability, food instability, environmental factors, neighborhood challenges, and access to high quality education and health care. Studies show SDOH can influence as much as 80-90% of a person’s health outcomes.

Related reading: Health Systems and Researchers Can, and Must, Work to Advance Community Health and Equitable Access.

How MedStar Health works to rebuild trust.

Throughout MedStar Health, we’re working to be trusted collaborators working to improve health in our communities. There are many examples of how we place patient perspectives and community partners at the center of our actions and our research. 

Here are a few of my favorites:
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• Community Violence Intervention Program: Designed to reduce and prevent new injuries and retaliatory violence by promoting an improved sense of self for each patient. Through culturally competent and trauma-informed care and strategic partnerships, the program works to heal physical and hidden wounds. 

• D.C. Safe Babies Safe Moms Program: This partnership between MedStar Health, Community of Hope, and Mamatoto Village focuses on families to improve the health and well-being of mothers and infants in the District. 

• PG Healthy Start Program: One of our newest programs, which aims to significantly reduce infant mortality and improve maternal health by addressing needs during pregnancy and up to two years after delivery. 

• Ryan White Program (RWP): Through MedStar Washington Hospital Center and community partnerships, RWP works to identify neighbors at risk of HIV disease, help them learn their status with HIV testing, and ease access long-term care to improve their quality of life and reduce the chances of transmitting the virus.

Researchers and clinicians share the same responsibility: to help our patients and our population achieve better health. By building intentional partnerships that place our patients’ perspectives at the center of our work, we can begin to restore the trust in health, technology, and science that benefits all of us.