In a recent interview with Healio, Roy Perlis, MD MSc, Director of the Center for Quantitative Health at Mass General, discusses new research documenting a significant decline in Americans’ trust in physicians and hospitals that occurred during the pandemic.
In this study, Perlis and colleagues examined data from 24 waves of internet surveys conducted during and after the pandemic as part of the COVID States Project among individuals aged 18 years or older across 50 States and the District of Columbia. Participants completed surveys every one to two months between April 2020 and January 2024. Participants were asked “How much do you trust hospitals and doctors to do what is right?” followed by four choices (a lot, some, not too much, or not at all). The sample included more than 582,000 responses from more than 443,000 adults in the United States.
At the outset of the COVID-19 pandemic (April 2020), 71.5% (95% CI, 70.7%-72.2%) of the participants reported higher levels of trust in hospitals and physicians. However, in January 2024, the number of adults reporting higher levels of trust in physicians and hospitals dropped to 40.1% (95% CI, 39.4%-40.7%). Some of the characteristics associated with lower levels of trust included female gender, age 25 to 64 years, living in a rural setting, Black race, lower income level, and lower educational level.
Why Has Trust in Physicians and Hospitals Declined?
Although the current study cannot say exactly what caused this shift in trust, Perlis notes that during the pandemic, especially early on, there was a lot of misinformation about COVID-19 and how to treat it. Information about COVID-19 became highly politicized, and Americans often received rapidly changing or conflicting medical opinions. As public health leaders sought to push back on misinformation, they faced vitriolic attacks.
But it wasn’t just the pandemic that shook Americans’ trust in the health care system. The survey asked participants who reported low levels of trust to explain why they did not trust their medical providers and hospitals. For some people, bad experiences with healthcare — feeling like they or someone in their family had been mistreated — contributed to their distrust. Others reported feeling that physicians had conflicts of interest — that they might be driven by financial incentives or might be unduly influenced by other groups like the U.S. government. Some reported that their distrust stemmed from experiencing bias, feeling discrimination on the basis of their gender, race, or sexual identity.
What Are the Downstream Effects of Distrust?
Traditionally physicians have represented a key element in public health outreach efforts. Most adults meet with a physician regularly. In this setting, physicians attend not only to acute medical issues but support preventative care including vaccinations, blood pressure monitoring, and cancer screening, and provide information on healthy behaviors, such as diet, exercise, and smoking cessation.
What happens when patients stop trusting their healthcare providers? Although this study was not designed to examine long-term health outcomes, Perlis and colleagues observed that levels of trust did affect certain health behaviors. Specifically, they observed that adults with higher levels of trust were more likely to have received COVID-19 vaccinations than those with lower levels of trust (a lot of trust vs. no trust: OR, 4.94 [95% CI, 4.21-5.80]). A similar pattern was observed for COVID-19 boosters and influenza vaccines.
The findings of this study raise the possibility that this shift in how Americans view physicians and healthcare institutions could have long-lasting public health implications. Lack of trust could influence how we respond to the next pandemic but may have other, more global effects on overall health. Thus, effective interventions aimed at restoring trust could have benefits, not only for future pandemics, but for the health of Americans more generally.
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Q&A: Health care community must ‘take steps to rebuild trust’ lost during pandemic (Healio)
Perlis RH, Ognyanova K, Uslu A, Lunz Trujillo K, Santillana M, Druckman JN, Baum MA, Lazer D. Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults. JAMA Netw Open. 2024 Jul 1; 7(7):e2424984.
Roy Perlis, MD, MSc is the Director of the Center for Quantitative Health at MGH and Associate Chief for Research in the Department of Psychiatry. He is the Ronald I. Dozoretz, MD Endowed Professor of Psychiatry at Harvard Medical School and Associate Editor (Neuroscience) at JAMA's new open-access journal, JAMA Network - Open. His research is focused on identifying predictors of treatment response in brain diseases, and using these biomarkers to develop novel treatments. He directs two complementary laboratory efforts, one focused on patient-derived cellular models and one applying machine learning to large clinical databases.
