Americans show distrust of medical profession in survey
Based on data from an international health care survey, the United States is near the bottom of the list when it comes to public trust in the medical establishment, Harvard researchers report.
On the other hand, when asked to rate their own medical care, Americans are among the most satisfied.
Experts said the seeming contradiction, reported in the Oct. 23 issue of the New England Journal of Medicine, is actually not surprising.
"It fits with decades of data on the American public's trust in institutions, in general," said Michael Gusmano, a scholar at the Hastings Center, a Garrison, N.Y.-based research institute that focuses on health care.
"People hate Congress," Gusmano noted, "but they like their own representatives."
However, the distrust is also probably related to the U.S. health care system itself, according to Gusmano, who was not involved in the study.
He noted that Americans have unequal access to health care, and hospitals and other providers often turn to "overt commercialization" of their services. "The commercial nature of medicine in this country can turn a lot of people off," Gusmano said.
Report author Robert Blendon said it's up to "medical leaders" to restore Americans' faith in the profession.
Professional societies, such as the American Medical Association (AMA), can seem to value doctors' self-interests more than patients' well-being, according to Blendon, a professor of public health, health policy and political analysis at the Harvard School of Public Health.
"They need to take more visible stands on issues broadly affecting people's health, and not just the [medical] profession," Blendon said.
The AMA responded in a statement released Wednesday: "The physician leaders of AMA adopted a new strategic vision in 2012 focused on improving health outcomes for patients, accelerating change in medical education, and shaping delivery and payment reforms to ensure physicians thrive in sustainable and satisfying medical practices that provide high-quality, patient-centered care."
For the study, Blendon's team looked at several public polls on health care from the past four decades. One, done by an international consortium of universities, surveyed people in 29 developed countries between 2011 and 2013.
In that poll, the United States was tied for 24th place (with Croatia) when it came to trust in the medical profession. Overall, 58 percent of Americans agreed with the statement: "All things considered, doctors [in your country] can be trusted."
That compared with three-quarters or more of the populations in countries including Switzerland, Denmark, the Netherlands, the United Kingdom and France.
Yet, the United States shot up to third place (behind Switzerland and Denmark) when people were asked to rate their last doctor visit: 56 percent said they were "completely" or "very" satisfied with their care.
There was, however, an economic divide. Only 48 percent of lower-income Americans (defined as a family income of less than $30,000) gave their doctor high satisfaction ratings, versus 59 percent of people with higher incomes.
"There's still a disparity even when you're looking at people who are in the system and getting care," Gusmano said. "I think those disparities are part of the reason for the findings on Americans' trust of the institution as a whole."
Blendon said other polls have shown that Americans see soaring health care costs as a huge issue for the country. And low-income people face particular obstacles.
"Medical leaders need to take clear stands on issues important to low-income Americans—like opposing budget cuts to community health centers," Blendon said. Community health centers, partly funded by state and federal governments, provide primary care to about 23 million Americans, according to the National Association of Community Health Centers.
Dr. Robert Wergin, president of the American Academy of Family Physicians (AAFP), said he was disappointed by some of the poll results. "That 24th place is certainly not good enough. We can do better," he said.
"I think this highlights the problems of our fragmented health care system," Wergin said. "People put trust in their own doctor, but not the system."
He noted that in Europe, there is a greater concentration of primary care doctors—which might be one reason for the "better feelings" toward the health care systems there.
According to Wergin, the AAFP and other family medicine groups have long been adopting policies aimed at giving more Americans a consistent source of primary care that "looks at the whole person."
Wergin said the AAFP will be unveiling a new plan—dubbed Family Medicine for America's Health—at its annual meeting this week.
The goal, Wergin said, "is to meet the triple aim of better care, better outcomes and lower costs."
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