Trust between patients and physicians is the cornerstone to improving how health care is delivered, especially in developing a more equitable system. It can even affect physician burnout.
“For a variety of reasons that vary from community to community, we have a system where there is broken trust,” Kavita Bhavan, MD, an infectious diseases specialist and chief innovation officer at Parkland Health and Hospital System in Dallas, said during an episode of the “AMA STEPS Forward® Podcast” with Marie Brown, MD, an internist and the AMA’s director of practice redesign.
The COVID-19 pandemic laid bare the inequities that are in the system, including vaccine hesitancy. At Parkland Health, most patients come from historically marginalized racial and ethnic group, lack adequate insurance coverage, and live in communities with multiple inequities.
It is the responsibility as physicians “and as health systems to really engage better with the patients and the populations that we serve to identify those areas where trust is broken and find ways to effectively bridge that gap,” Dr. Bhavan said.
In fact, studies have shown that trust—between patients and physicians as well as doctors and their organizations—can lead to less physician turnover. To that end, the AMA also recently joined the Coalition for Trust in Health and Science, which aims to increase trust in medicine.
Trust is also closely related to feeling valued. The “AMA Coping with COVID” survey found that feeling valued is associated with 60% lower odds of burnout. By establishing trust with patients—and organizations—it can make a difference for everyone.
Knowing that trust was going to be a barrier, it was important to design everything intentionally with that in mind, Dr. Bhavan said during a separate “AMA STEPS Forward Podcast” episode. That’s because trust is an enormous component for people who traditionally avoid seeking health care, especially because of child care and other issues.
Uncovering mistrust
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Parkland Health has had success in building trust in a number of areas, including vaccine hesitancy. While flu vaccines were free for anyone in Texas, data showed that people living in economically or socially marginalized areas were dying from influenza at twice the rate of those in wealthier areas. Data also showed that Hispanic patients traditionally have the lowest vaccine rates when compared with white and Black patients.
To uncover mistrust, Dr. Bhavan spoke with a group of first-generation Hispanic college-bound students who were interested in careers in medicine. In working with the students, they discovered trusted resources are in the church and the school. It’s not by listening to NPR or seeing advertisements on billboards encouraging people to get vaccinated.
“The difference was to really work through what the trust issues were, to talk with these really smart young people who want to go into health care and empower them with good knowledge so they can help dispel misinformation,” she said.
The result: In January 2020, an influenza clinic that may have normally seen 50 or so people show up attracted 400 people. That community engagement approach led to days where they were able to vaccinate more than 1,400 people in 16 hours. For some of the people showing up, it was the first time they had ever had a vaccine, Dr. Bhavan said.
Gaining patient trust
Another area Dr. Bhavan worked on improving trust in was with child care, because it is one of the leading causes of missed appointments for women. With the establishment of Annie’s Place—an off-campus child care center for patients during their medical appointments—it was another way to gain trust and improve quality of care.
Nearly 70% of patients who have accessed Annie’s Place have never left their child with anyone outside their family, so “this is a trust issue too,” Dr. Bhavan said, noting building trust is “a ripple effect—the trust in the care that you’re about to engage in and that the health system cares as well to provide this for you.”
