Currently Viewing:
The American Journal of Accountable Care September 2019
Achieving a Culture of Health: Steps for Engaging State Government
Dennis P. Scanlon, PhD; Jocelyn M. Vanderbrink, MHA; Mark Sciegaj, PhD; and Brigitt Leitzell, MS
Implementation Variation in Natural Experiments of State Health Policy Initiatives
Diane R. Rittenhouse, MD, MPH; Aryn Z. Phillips, MS; Salma Bibi, MPH; and Hector P. Rodriguez, PhD, MPH
Current Value-Based Care Models Need Greater Emphasis on Specialty Care
David Roer, MD; Mayumi Fukui, MBA; Natalie Smith, MSPH; Allen R. Nissenson, MD; and Bryan N. Becker, MD
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Building Trust Can Improve American Healthcare
Richard J. Baron, MD, President and Chief Executive Officer, American Board of Internal Medicine and the ABIM Foundation
The Cost of Learning: Participating in APMs Despite Projected Financial Losses
Jessica Walradt, MS; Hannah Alphs Jackson, MD, MHSA; Brian Walsh, BA; and David Manning, MD

Building Trust Can Improve American Healthcare

Richard J. Baron, MD, President and Chief Executive Officer, American Board of Internal Medicine and the ABIM Foundation
The promise of high-quality, affordable care aligning with the individual needs of patients remains elusive. Increasingly, the missing ingredient seems obvious: trust.
The American Journal of Accountable Care. 2019;7(3):24-25
Over the past 30 years, even after major strides to expand access, improve outcomes, and control costs, fulfilling the promise of delivering high-quality, affordable care that aligns with the individual goals and needs of this country’s patients remains elusive. Increasingly, the missing ingredient seems obvious: trust.

Everyone recognizes the value of trust in underpinning meaningful, resilient patient–physician relationships. But it’s more than that. Trust in an increasingly complicated and integrated healthcare system requires an ecosystem in which organizations and the individuals within them proactively model trustworthy behavior and nurture it in others. Unfortunately, data show that our levels of trust are low, while the precipitous rise in cynicism and misinformation spreads throughout society.

Gallup polling reveals that confidence in almost all institutions in the United States, including Congress and the news media, has greatly deteriorated over the past 4 decades. What’s especially sobering is the fact that the most dramatic decline has occurred in “confidence in the medical system,” which fell by more than 50%, from 80% in 1975 to 38% in 2019. Confirming this trend, data from the General Social Survey show that confidence in the people running medical institutions has also steadily dropped, from 61% in 1974 to just 37% in 2018.1

As trust in healthcare has declined, alternative sources of information have arisen to challenge and even supplant rigorous scientific knowledge and experience—sources that are accessible on a variety of platforms that make little effort to validate their medical claims. Such information, be it true or false, can have a powerful and potentially dangerous impact on patients. The stubborn persistence of antivaccination messages in the face of overwhelming evidence of vaccine safety is a case in point.

News coverage of dozens of children contracting measles and communities declaring public health emergencies should be urgent clarion calls for a national conversation on rebuilding trust in medicine and science. Overcoming current trends requires a different, collaborative, 360-degree approach that engages everyone. Each aspect of the healthcare ecosystem must examine itself and proactively choose to build trust if we ever hope to improve our healthcare system.

The Trust-Building Journey

At the American Board of Internal Medicine (ABIM), we know firsthand what it’s like to enjoy, and then lose, trust. That’s one of the things that makes me a wounded but wiser messenger. It is humbling to accept that one’s organization has lost trust, as did ABIM, and yet the situation offers an incredible opportunity for transformation. In 21st-century America, getting to trusting relationships is a journey, not a destination. It’s a continuous process that makes us better. ABIM’s organizational learnings about rebuilding trust have educated us about the risks for other healthcare organizations and the importance of proactively focusing on building trust.

Two points of good news: First, although rebuilding trust may require new technology and procedures, it isn’t rocket science. It requires us to act toward others the same way we would like to be treated. Second, we can build on work that’s already being done to replicate and apply those hard-earned lessons to practices across the country. That’s already happening.

Thinking back to one of my own patients, it was her first visit to my office, and I was 30 minutes late. By the time I saw her, she was understandably furious. Instead of being defensive, I apologized sincerely. She calmed down. We were able to start over and tackle the issue that brought her in. For 20 years, we worked together in sickness and health, as patient and physician. That encounter taught me that people need to be respected and heard in the doctor’s office or the trust needed to care for them will never develop.

Last year, the ABIM Foundation asked leaders in healthcare to examine trust in a variety of contexts, interactions, and relationships—including between physician and patient, physician and physician, physician and health system, health system and payer, and physician and government and within healthcare systems—within the communities that they serve. Since January, we have published a series of Viewpoint articles in JAMA based on those discussions, accompanied by suggestions of practical steps to nurture trust, better support patient care, and help laypeople develop a more discerning eye for credible medical information.


 
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