On May 12, the Primary Care Collaborative (PCC) and the ABIM Foundation hosted a webinar exploring how strong, ongoing relationships between Americans and primary care can help overcome challenges created by growing mistrust in health care.
Moderated by Katherine Gergen Barnett (Boston Medical Center Department of Family Medicine, PCC), the discussion featured Lisa Fitzpatrick (Grapevine Health), Barbra Rabson (Massachusetts Health Quality Partners) and Asher Tulsky (Boston University Chobanian & Avedisian School of Medicine).
Gergen Barnett kicked off the conversation by highlighting the importance of trust, labeling it a both visible and invisible infrastructure of medicine as clinicians try to reach patients. She highlighted how historic low trust in medicine and health care institutions—paired with misinformation spreading at unprecedented speed—has contributed to worsening health outcomes and a deemphasis on preventative care.
Panelists built off Gergen Barnett’s premise, exploring how different challenges that erode trust contribute to lower outcomes. Fitzpatrick emphasized that trauma—including more subtle trauma, such as living through scarcity or poverty—can shape people’s health care decisions and make them reticent to seek or trust care. Tulsky concurred and added that the challenge is compounded by limited time with patients, which undermines clinicians’ ability to communicate up-to-date evidence and approaches to care. Rabson said that the data (via the Wake Forest scale) found this mistrust to be especially pronounced in Black, Latino and Asian patients.
Fitzpatrick then went a bit more in-depth on her experience at the patient engagement organization Grapevine Health, which came from her Dr. Lisa on the Street video series. Talking with everyday patients (and non-patients) on the street, Fitzpatrick found that many people felt bogged down by medical and research lingo when trying to have honest conversations with their clinicians as they seek a trusted, relatable messenger—tying back to Tulsky’s assertion about the challenges of communicating evidence effectively. She emphasized building personal, real connections with people by using simpler, clearer language that levels the playing field and making a concerted effort to understand and empathize with patients.
Tulsky added that once you lose a patient’s trust, it is incredibly difficult to gain it back (often without the second chance to do so).
Rabson relayed how many patients say that clinicians consistently make assumptions about them that are oftentimes completely untrue instead of just asking questions. Instead of their health being a conversation with shared decision-making, they feel like they are being talked down to.
Looking towards further solutions, Tulsky highlighted that clinicians being taught to be more conversational and even a bit negotiatory pays dividends. Clinicians may not be able to get to every problem a patient is facing, but by asking “what’s on your mind today? What are your concerns?” allows a patient to be heard and have their pressing issues dealt with rather than just going through a laundry list of simply diabetes or blood pressure checks. A clinician can get to these diagnostics at the next appointment, but if a patient disliked their experience and didn’t feel seen, then they might not come back at all.
Gargen Barnett hammered in again the importance of effective interpersonal communication. As a clinician, you learn a new language when it comes to medical jargon, and part of your job is to translate it into a way the patient can better understand.
Artificial Intelligence (AI)’s role in clinician trust was also brought up later in the conversation. Rabson claimed that she saw an article that really stuck with her, arguing that AI implementation should be moving at the speed of trust instead of the speed of profit. AI is a gamechanger when it comes to reducing administrative burden and supporting patients, but she contends that there still needs deep transparency in its usage.
Fitzpatrick agreed that AI can be a great assistance tool, yet many patients are unaware of what the scope of AI is. Many attach AI to their umbrella fear of deepfakes and generative images and not its important uses for clinicians especially pre and post-visit. Educating patients on the scope and even how they can leverage these tools could prove critical, while making sure that the human touch of care is not lost. Tulsky agreed, saying that there’s an opportunity to utilize AI as a collaborative tool to effectively get answers.
Ultimately, panelists agreed that patients lacking trust in clinicians isn’t a new phenomenon. However, as misinformation and a primary care shortage continues to accumulate, cultivating robust patient-clinician relationships built on strong communication and understanding is an important way to improve trust.