MELISSA LEVY Senior Research Executive
RACHEL SANDFORD Associate Director
In a world where trust is supposedly in crisis, the vast majority of us say we trust our doctors to tell the truth (92% in the UK).54 Doctors are among the most trusted professions (second only to nurses at 96%)55 and have consistently been at the top of the tree year after year. But do we really trust them as much as we say we do? Our actions may suggest otherwise.
There is no doubt that trust matters. There is evidence that it can have a significant impact on treatment outcomes. Adherence to medical regimes is often linked to trust in a patient-doctor relationship. If a patient does not trust their physician’s advice or treatment decisions, this can cause poor adherence, resulting in poor outcomes. Adherence rates have been found to be three times higher in primary care relationships where high levels of trust are coupled with the physician’s knowledge of the patient.56
However, the world is changing. The healthcare system looks very different now than it did only a decade ago. We are moving away from the traditional one-way, unequal doctor-patient relationship, towards a more balanced conversation. There are two main factors influencing this; a greater patient ownership of both our health and health data, and the loss of the ‘family doctor’.
Patients are now better able to seek a second opinion when they are dissatisfied with the advice they receive. Patient support groups, patient associations, and ‘Dr Google’ are all ways in which patients (especially those with chronic conditions) can educate themselves on their treatment options. This is particularly prevalent in HIV where there is a strong community element to the condition; friends talk about their medications and often deliberately take the same ARVs (anti-retrovirals) as each other, while patient support groups offer up to date information about novel treatments to consider.
We are also monitoring our own health more than ever, with one in ten participants in our latest Global Trends Survey actively using a connected health device.57 As patients educate themselves more about their options, they are able to play a much less passive role in their treatment decisions.
The nature of general practice is also changing. Historically a GP would look after a whole family, from grandparents to grandchildren, understanding their shared medical history, social background, and economic situation, thus enabling them to act as a trusted advisor as much as a physician. Nowadays it can be a rarity to see the same GP more than a few times, let alone share them with other members of your family. Telemedicine has played a role in this, with 34% of doctors surveyed in the UK reporting having used telemedicine for remote consultations in 2017.58
Our studies have shown that patients’ level of trust in physicians can vary depending on their condition and the professional’s role. For example, patients with long-term conditions can sometimes have lower levels of trust in their GP, and are more likely to see GPs as ‘gatekeepers’ to specialist care. And while specialists are seen as experts in their field, the overall relationship may still not be a close one, due to the infrequency of contact. For this reason, specialist nurses are often trusted above all. They have a more personal relationship with the patient, as well as expert knowledge on the day-to-day realities of a disease, beyond that of the specialist doctor. For example, stoma* nurses are able to assess a stoma and identify exactly which product would work best for that specific patient in a way that the surgeon would not.
Despite all of this though, overall trust in doctors (and particularly GPs) remains high. And results from the GP Patient Survey back this up; 96% of patients in 2018 said that they had confidence and trust in the healthcare professional they saw at their last appointment, including 69% who said they definitely did.60 Qualitatively, patients tell us that while they want to be involved in decisions about their own care, they rely heavily on the doctor’s opinion and advice. While they might be taking more ownership of their health, this doesn’t mean that they trust their doctor any less.
So, yes, the world is changing, the health landscape is changing, patients are changing, but amongst all of this is one constant – our trust in our doctors.
“Over six in ten Europeans trust the news they receive from the radio, television and printed news. But only half trust online news, and just a quarter news from social mediaVIII”
*A stoma is an opening on the abdomen that can be connected to either your digestive or urinary system to allow waste (urine or faeces) to be diverted out of your body.59