Helping patients with well-founded mistrust in medicine

Doctors and health systems face an undeniable truth as they work to build trust with patients.

Some patients, especially those in minority groups, don’t trust physicians or health systems for legitimate reasons. Members of minority communities have had unpleasant or problematic interactions with clinicians.

Dr. Margot Savoy, chief medical officer of the American Academy of Family Physicians, says it’s important to understand that Black patients have well-founded reasons for lacking trust in doctors. And that’s important to recognize as physicians tackle problems such as improving vaccination rates and fighting misinformation.

Critically, she says physicians and health systems must understand that for Black patients, a well-earned mistrust goes beyond abuses of generations past.

Savoy winces when she recalls repeated references to the notorious Tuskegee Study in the 1930s. Hundreds of Black men were left untreated for syphilis so doctors could analyze the impact on the body, with some dying and most being denied penicillin, even when it became available.

Savoy bristles at references to Tuskegee, partly because she says it’s incorrect to think about Black Americans as a community who thinks about issues in one way.

More importantly, she points that for Black Americans, mistrust of doctors is related to their current experiences with the health system. By assuming apprehension is rooted in historical events, doctors deny the current experiences of their patients and create barriers to providing patients the help they need.

“When people are telling you that they're having a concern about whether or not they're going to experience racism in the medical establishment, they're talking about things that happened yesterday,” Savoy tells Chief Healthcare Executive®.

“When they went in the pharmacy and then they had an experience and it went this way, or when their grandma was admitted to the hospital and something happened this way, or when their friend was in the ER and something happened that way,” she says. “They're not talking about things from years and years ago. They're talking about yesterday.”

• Read more: How doctors and health systems can counter vaccine skepticism

Addressing unconscious bias

In her book, “Legacy,” Dr. Uché Blackstock’s memoir on dealing with racism in medicine, she pointed to both history and current experiences impeding efforts to vaccinate Black Americans during the COVID-19 pandemic.

“Such incessant assaults on our basic humanity have created an instinctive mistrust that is well-founded,” she wrote. Blackstock also wrote, “Anytime there is mistrust, misinformation has an opportunity to flourish.”

Black Americans are less likely than other Americans to get vaccinated, according to data from the U.S. Department of Health & Human Services. Black Americans are less likely to survive a host of cancers, according to the American Cancer Society.

Health systems and physicians are going to have to recognize the reality that minority groups still have troubling experiences when they seek care.

“There are things that we do that continue to perpetuate certain stereotypes that create outcomes and experiences for people that create disparities in the care they receive and also how they experience the care when they're receiving it,” Savoy says. “And so, as health systems, as healthcare leaders, it's our obligation to address those things.”

Savoy says health systems must begin by listening to patients, and they need to confront unconscious bias in their interactions.

“People don't like to talk about it, but this is where that unconscious bias part becomes really important,” she says. “You don't even realize that you're doing the thing that that comes across or is perpetuating that racism or that uncomfortable space for people where they don't know that they can trust you.”

Black individuals and those in other racial minority groups experience difficulties when trying to get care. Women have certainly found situations where they aren’t being heard.

“As a Black person, I know that there are things that happen that I'm confident happened for reasons that are because I'm Black,” Savoy says. “There's sometimes things that happen to me because I'm a woman, and that also creates a lack of trust in the healthcare system. So this lack of trust isn't just sort of limited to one group.

“And so our job as clinicians, our job as physicians, is to be really, really thoughtful about creating enough space for people to share that story with you and actually what's worrying them,” she says.

‘Hearing people’s lived experiences’

Physicians who express curiosity can help get patients to talk about their hesitancy to get vaccinations, she says.

But it’s important for doctors to hear what the patient is saying without judgment.

“I do think that we have to just assume that not everybody trusts you just because you've got the white coat on,” Savoy says. “And we have to be really open and thoughtful about hearing people's lived experiences, hearing about what's going on with them, and being truly open to hearing what they get back to you, so you're not judging it. You're not telling them that didn't happen or telling them that's not the truth.”

Doctors are certainly seeing more patients confused by misinformation. Nearly two out of three doctors (65%) say that misinformation is affecting their ability to deliver care to their patients, according to a survey released this week by The Physicians Foundation.

If a patient offers reasons they’re leery of vaccines that aren’t medically accurate, doctors should still hear what the patient is saying within the context of the patient’s own experiences. Their understanding of medicine may be incorrect, but they may still have had bad experiences with the health system that are affecting their trust.

Doctors shouldn’t express a judgment, but they should ask questions.

“Ask them what their goals and what their opportunities are, and how we could work together to get to their health,” Savoy says. “And if their fear is being admitted to the hospital, the reality is, for example, getting the flu shot, getting your pneumonia shot, being up to date prevents you from that outcome.”

By focusing on the patient’s concerns of ending up in the hospital, and offering an alternative that greatly reduces the risk, the conversation shifts, she says.

“You're not talking necessarily about their race, you're not necessarily talking about some of these other things, but you're getting at what really matters to that person in front of you at that moment,” she says.