Trust in Health Care in the Time of COVID-19

Abstract

Trust is foundational for the relationship between patients and clinicians.Patients often disclose profound personal information and trust this will remain confidential.Clinicians work to gain trust so patients are willing to accept their diagnoses and recommended treatments, including undergoing invasive procedures and taking medications indefinitely for chronic conditions.To achieve this level of trust, clinicians and health care systems must, above all, convince people that they put patients' best interests above any financial or nonfinancial self-interest of their own.However, trust in health care has declined during the past half-century.In a 1966 survey of adults in the US, 73% said they had great confidence in the leaders of the medical profession; but in a 2012 survey, only 34% said this. 1 Many factors are thought to contribute to the declining trust in clinicians and organized medicine, including the rise of managed care and related financial incentives, highly publicized conflicts of interest between clinicians and pharma and device manufacturers, limited time for communication, fragmentation of the patient-clinician relationship, and consumerism. 2,3Trust in health care is even lower among Black persons and people of other communities who have experienced barriers to health care access, health care disparities, and overt racism within the health care system. 4he coronavirus disease (COVID-19) pandemic has created new threats to trust.This may have been inevitable when facing a novel pathogen that defied preconceived expectations (eg, spread from asymptomatic carriers), leading to rapid advances in scientific understanding of the disease and frequently changing recommendations for prevention and treatment.However, the preexisting distrust in science was exacerbated by conflicting messages, questionable treatments reported in research publications, concerns about political interference in public health recommendations and decisions regarding the efficacy of therapeutics, and pseudoscience and conspiracy theories.In addition, Black and Latino communities faced inadequate testing, financial barriers to care, and disproportionately high rates of COVID-19 cases and deaths, further threatening their trust in physicians, the health care system, public health, and science. 5][8][9][10][11] Arora and colleagues 6 discuss concerns related to medical misinformation and offer countervailing strategies at the clinical and societal level, ranging from use of social media to spread messages supporting vacci-

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