Patient-Physician Relationships Will Thrive With Greater Trust

PHILADELPHIA, PA – The New England Journal of Medicine has published an article entitled "Mistrust in Science – A Threat to the Patient-Physician Relationship" by Richard J. Baron, President and CEO of the American Board of Internal Medicine and ABIM Foundation, which reflects on how societal shifts and dramatic changes in the practice of medicine are putting trust between patients and doctors at risk.

Coauthored with Adam J. Berinsky, PhD, the Mitsui Professor of Political Science at the Massachusetts Institute of Technology and Founding Director of the MIT Political Experiments Research Lab, the article delves into the evolution of trust in health care and its importance, and how alternative sources of uncertain authority have filled the gaps left by declining confidence in medical institutions.

The authors also offer thoughts on how health care institutions and practitioners can counter skepticism in medicine through intentional and systematic efforts to know about patients' unique health circumstances and desired care outcomes, to explicitly acknowledge the competence of care team members, and to give meaning to facts by connecting them to an individual patient's predicament. In addition, it is often the unexpected messenger that provides credibility to scientific facts – as when an individual or group speaks against their own apparent interest, they state.

"In a period of dramatic changes in the practice of medicine, as well as broadly declining trust in various social institutions, it is worthwhile to examine what is happening to trust in medical institutions generally and the connection between trust in institutions and trust in the individuals within them. As the structures of institutions change, the authority ascribed to those institutions may change as well," the authors write.

Research has shown that the quality of health outcomes depends on a stable foundation of trusting relationships. Yet trust in medical leaders has been in steady decline since the mid-1960s, according to Harris polling.

The ABIM Foundation has embarked on an initiative to help drive a national conversation about trust in health care, by convening health care leaders for discussion and through its Trust Practice Challenge, an open call for existing health care practices that nurture trust.

"Dr. Baron's scholarship on the issue of trust is rooted in 30 years of experience as a community-based primary care physician, a historical appreciation of the social transformation of medicine, and a clear understanding of the contemporary levers that can support or derail positive interactions in health care," said Christine A. Sinsky, MD, Chair of the Foundation's Board of Trustees. Sinsky said the NEJM article would help further the Foundation's efforts to spotlight the topic.

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