The Power of Trust

By Matt Fisher, General Counsel, Carium
Twitter: @matt_r_fisher
Twitter: @cariumcares
Host of Healthcare de Jure#HCdeJure

What is trust? It can be something very simple, but also difficult to obtain and quantify at the same time. At its root, trust is about knowing that someone or something can be counted upon. The assurance exists that there is a mutual support and a desire to help each other. While those concepts underlying trust may seem simple, finding them in the real world can be difficult. It is also way too easy for trust to be broken with a single word or action. Once trust is broken, restoring is a long hard road, if restoration is even fully possible.

The Trouble for Healthcare

A recently published study examined public trust in chronic conditions, especially cancer, among patient populations for data from various sources. The research asked individuals to describe trust in cancer information from physicians, government health agencies, family and friends, charitable organizations, and religious organizations. The research also looked at how COVID-19 impacted the feelings of trust.

The research built upon previously documented trust barriers to patients accessing routine screening for cancer or HPV. The barriers often fall along racial and ethnic lines, with non-white patients expressing the lowest degrees of trust. The researchers stated that the purpose of examining trust in healthcare information sources is to understand how individuals participate in disease prevention. Accessing disease prevention information is important during the time of a public health crisis or other impact on health. If trust does not exist, then the ability to manage an issue becomes more difficult.

The data collected in the research revealed a significant and material trust in information from government health agencies among different ethnic and racial patient groups. Specifically, non-Hispanic black patients showed the biggest decline in trust whereas other groups did not show a statistically significant change. At the same time, trust in information received from a physician, family and friends, charitable organizations, and religious organizations showed no significant impact as a result of the pandemic across racial or ethnic groups.

The findings reveal a problem for what should be a reliable source of healthcare information. The erosion in trust of healthcare information from the government is a shortcoming as government agencies have an essential role to play with public health efforts. Further, the politicization of healthcare issues will continue to factor into the trust determinations with unknown future ramifications.

The Broader Picture

There are also broader picture issues to consider. As noted in the study, there is a well known and widespread disparity when it comes to trust in the healthcare system from different racial and ethnic groups. As already suggested, the breakdowns traditionally show that non-white populations are less likely to have trust in the system. The lack of trust shows up from implicit bias that impacts care provided or even offered and the higher likelihood of negative outcomes for non-white patient populations.

When the historical issues are combined with ongoing complications in obtaining all necessary and appropriate care, it shows that trust is a problem. Large groups of patients cannot be left on the outside looking in or self-selectively foregoing care because there is a feeling that what they need will not be provided. The concession or forced acceptance of the shortcomings arguably reflects broader societal issues that fracture along similar lines.

Addressing and overcoming those issues cannot occur with a quick fix or quickly shifting attention. Building back to a point of trust will take a lot of time and dedication as well as adopting new approaches. Following the same old song and dance will not produce change.

Will Technology Help?

Part of charting a new course will necessarily involve determining the role of technology. Technology based solutions are an unavoidable part of healthcare at this point. The reason for ubiquity of technology is its ability to break down old barriers and advance new paradigms. Those possibilities do call for considering the nature of the old problems and then using due care to develop around those limitations. While that approach may take extra time and effort, the pay off will certainly be well worth it.

What will it take for technology to follow the path so far less taken and produce change? For one, it requires involving the voices and perspectives of individuals who have not always been given that opportunity and/or attention. How can different viewpoints be represented if not given a seat at the table? That may be an obvious statement, but it is admittedly not an approach that has a ready way to implement. It will certainly take getting out of a comfort zone and actively pursuing new voices. Developing new networks or making some cold call connections will be necessary, but those efforts will very likely bear unexpected fruit.

Call To Action

The immediate call to action is just start doing something. Allowing the existing status quo to linger enables current problems and inequities to spread tentacles even further. No time is better than the present to start rooting out all of the issues and taking the first steps to laying the foundation for new trust in healthcare.

This article was originally published on The Pulse blog and is republished here with permission.