On a Friday afternoon, I knocked on the door of an apartment that is located in a neighborhood for public, low-income housing. An African-American woman, Ms. Janet, answered the door.
“Hi. My name is Faiz, and I’m a first-year medical student working with the Georgia DPH [Dept. of Public Health] to offer free HIV testing. It only takes a few minutes, and we have some pens, gift cards and shirts for anyone who gets tested.”
Ms. Janet, in her late 50s, stood in the doorway, looking at me closely to figure out if I’m trying to scam her or, by a slim chance, actually offer a service she could benefit from. After what seemed like hours, she conceded, “Yeah, come inside.” I entered her humble space that was home to at least four adults and two children. The kitchen was the size of a cubicle office and the living room about double that. A short hallway led to the rest of the apartment. I wondered what it looked like, what the family’s lifestyle entailed.
I kneeled before her small living room table while she sat on the couch. Ms. Janet’s two daughters and son, all about 25-30 years old, were seated around the table as I set up my HIV testing kit. Meanwhile, a young boy, about four or five, was showing me a scratch on his elbow until Ms. Janet yelled at him not to bother me. He didn’t want to leave until I gave him a Band-Aid. I made him giggle then gave him the cartoon-printed Band-Aid that he liked, at which point she let him stay. It felt warm that she allowed the boy to hang around me — a tall, bearded, brown-skinned stranger.
Trust is not a gift granted frequently to those of foreign heritage in the homes of southern Georgia.
As I completed five rapid HIV tests with my mentor, I spoke to them about their health history, current habits and what they knew about the virus and its treatment. However, upon exiting the doors I was thoroughly disturbed at how little I actually knew about the individuals we tested. I had just entered a family’s home, knew where they lived, how many children and grandchildren lived there, their birthdays, and what their signatures looked like. I even drew their blood and knew their HIV status. Yet, if you asked me what even one of the family members did as a hobby, you’d leave me speechless. The only personal encounter I recalled was my brief exchange about cartoons with the young boy who stood by me earlier and, frankly, that was the most human.
While I am in my first year of medical school and my experience with the family was via a door-to-door rapid HIV testing project, I wondered how many other medical students and practitioners felt a similar disconnect in their clinical interactions with patients. From sequencing the human genome in its entirety to generating insulin-producing pancreatic beta cells that are functional in mice, it is obvious that American healthcare delivery has advanced at light-speed with regard to its technology. However, it has not budged nearly as much in the area of human connection. It is for this reason that public trust in physicians is not at its highest potential.
A 2019 Pew Research Center study discovered that 57% of Americans believe medical doctors usually care about their patients’ best interests. For a profession that is centered around the patient, 57% is not a comforting figure. On an international scale, the U.S. ranks 24th out of 29 countries in a survey that measured how many adults agree with the statement, “All things considered, doctors in [your country] can be trusted.” In the same study, the public trust of U.S. leaders in the medical profession decreased from 73% in 1966 to 34% in 2012. From this data, it is clear that there is room for improvement in terms of the patient-provider relationship.
Various hypotheses account for these relatively low outcomes. The U.S. is unique compared to other industrialized nations in its lack of universal health care. Furthermore, the structure of government in the U.S. does not include physicians in public health-related policy-making as much as other nations do. The possible reasons for decreased public trust in medical providers will be explored in subsequent posts for this column.
Regardless, with this data in mind, it is important for students in medical education to understand that we are entering the profession at a time where the reputation that precedes us is not ideal. This also means that the capacity to alter this perception is dependent on the way we practice upon entering the workforce.
Solutions to this declining patient-provider relationship may exist in many ways ranging from education reform to policy changes. Specifically, with the advent of pass/fail curricula, studies have shown that medical students are exhibiting reduced stress, improved psychological well-being and greater group cohesion. These results provide hope that with a less stressful education, future physicians may graduate from medical schools less focused on numerical academic achievement. Thus, they might have the space to provide better patient care.
Another possible improvement includes increasing the involvement of physicians in policy-making. After all, physicians have the potential to bring tangible experience into policy and subsequently improve public satisfaction with health legislation. In a study from the Journal of Health Politics, Policy and Law, researchers concluded that the involvement of doctors’ groups in proposals to control costs and to prioritize the most effective medical treatments have garnered greater public support than involvement solely by politicians.
Ultimately, improvements must come from physicians if public attitudes are to improve. To achieve this, however, we must first gain a better understanding of why trust is relatively low and then look closely at potential solutions — whether through greater involvement in policy, improved education, or better legislation. As the country that spends the most amount of money per capita on healthcare, we must have greater standards for the quality of our care and of the relationship between patients and providers.
Image credit: Author, Faiz Saulat
Medicine has advanced in many ways except the ones that count the most. The following column invites you to question whether physicians still hold true to values of altruism, compassion, and humanity. We will explore the patient-provider relationship, the causes of distrust, disparities in medicine, and improvements in medical practice and education.