Do You Trust Your Doctor? The problem with belief in medicine

Trust is an essential ingredient in the practice of medicine and public health. Numerous studies illustrate how patients who trust their doctor are more likely to take medication as directed, return for follow up visits, change behaviors and have better outcomes.

Trust requires trustworthiness. In the doctor-patient relationship it boils down to three things, competence, communication and caring or motivation. Does the doctor know what she’s doing? Can she tell me what she’s going to do and why? Is she doing it for my benefit or hers?

But it’s complicated.

Unlike citizens of other developed countries, Americans are much less likely to trust doctors or believe in the health system. This stems in part from our for-profit health care. The US is the only first world country without universal health care.

Historically, trust in one’s doctor was based on a personal relationship. Home visits were routine. Doctors knew their patients and their families. As medicine grew more scientific, faith in medical practice was further buttressed by the legitimacy of science itself.

During the 20th century the foundation of trust shifted away from the personal toward the institutional. Hospitals, specialty groups, and insurance companies redefined the…