Recently, the ABIM Foundation brought together more than 150 leaders in healthcare and academic medicine for a 2018 Forum, focused on [Re]Building Trust. The meeting, spanning three days, brought many topics relating to trust in the healthcare arena to the forefront, including the current state of trust in healthcare, what helps to nurture trust versus what erodes it, and once trust is eroded, what can be done for it to be restored.
Richard Baron, MD, the President and CEO of the American Board of Internal Medicine and the ABIM Foundation, opened the Forum with thoughts about why the Foundation had chosen trust as a topic. He referenced the current climate in the nation and the growth of a “post-fact, post-truth” environment. “I think historians will describe this era as one of profound change, in which people come to doubt scientific facts,” Dr. Baron said. “This will change how people interact with doctors; they trust what we have to offer, but that trust is under profound threat.”
At the meeting, Adam Berinsky, PhD, presented the keynote address, discussing a reduction in confidence in experts and their expertise, a decline that also resulted in decreased public confidence in the medical field and medical science. Dr. Berinsky proposed a few lessons for those who are interested in combating misinformation. First, he said that it is insufficient to tell people to trust; one must persuade them to do so. Second, he said one needs to speak the audience’s language, rather than the jargon of the expert on display in medical journal articles. Third, as in the “death panels” study, a reliance on messengers speaking against their apparent interest is more likely to succeed; for example, the decision of McDonald’s to discontinue selling “super-sized” portions of French fries spoke volumes about the healthiness of the product. Fourth, he suggested that some people were beyond persuasion and recommended focusing energies on the group of people whose belief in false claims is soft or uncertain.
On the second day of the Forum, Dhruv Khullar, MD, MPP, presented about trust in health care, noting that while Americans are generally more satisfied with their own care than residents of other nations, they are considerably less likely to trust doctors as a profession, citing to three reasons why the lack of trust matters: trust makes people more likely to engage in healthful behaviors, trust can enable innovation, and trust helps us to respond to public health crises and other epidemics. Khrullar believes that rebuilding trust comes down to three dimensions: (1) do you know what you’re doing? (competence); (2) will you tell the patient what you’re doing? (transparency); and (3) are you doing this to help the patient or yourself? (motive). He believes that clear communication on every level will go a long way in rebuilding trust.
Thomas Lee, MD, MSc, Chief Medical Officer at Press Ganey, discussed research his firm had conducted to determine what patients really value. Through 937,000 patient surveys conducted after outpatient visits, his team analyzed what makes patients likely to recommend their physician or practice to others, which Dr. Lee said was the best marker for trust. Dr. Lee said the most important variable among the patient responses was confidence in the clinician, followed by teamwork, and then factors related to empathy and communication.
Small Groups
Small groups of attendees also met to narrow down their focus on a specific area of trust, such as patient trust in health systems and medical groups, physician and clinician relationships, and trust of minorities in the healthcare system. Each small group is expected to publish an article on its topic and submit for publication in peer-reviewed journals.