Trust in Doctors Crashed During the COVID Pandemic — And Remains Low

Trust in physicians and hospitals decreased sharply during the COVID-19 pandemic, and higher levels of trust were tied to greater odds of getting vaccinated for COVID-19 or influenza, according to a survey study of U.S. adults.

Among over 400,000 unique respondents, the proportion of adults who agreed they had “a lot of trust” in physicians and hospitals declined from 71.5% in April 2020 to 40.1% in January 2024, reported Roy Perlis, MD, MSc, of Massachusetts General Hospital in Boston, and colleagues in JAMA Network Open.

In regression models, factors associated with lower trust as of the spring and summer of 2023 included being 25 to 64 years of age, female gender, lower educational level, lower income, Black race, and living in a rural setting. Even when the researchers controlled for partisanship, these associations persisted.

“We were surprised by the magnitude of the shift,” Perlis told MedPage Today. “I think early in the pandemic trust likely increased above pre-pandemic levels, but it certainly came way down over the course of the pandemic.”

Not surprisingly, high levels of trust in physicians and hospitals were associated with greater odds of getting vaccinated for COVID-19 (adjusted OR 4.94, 95% CI 4.21-5.80) and influenza (aOR 5.09, 95% CI 3.93-6.59) compared with having no trust at all. Greater trust also increased the odds of receiving a COVID-19 booster (aOR 3.62, 95% CI 2.99-4.38).

Even reporting “some” trust was associated with higher odds of getting a COVID-19 vaccine (aOR 2.48, 95% CI 2.12-2.90) versus having no trust.

“We as physicians and public health officials can talk until we’re blue in the face about things like vaccination and other public health behaviors,” Perlis commented. “But if people don’t trust us, it doesn’t matter — we’re talking to ourselves.”

The decrease in trust during the pandemic could have long-lasting implications for public health in the U.S., he added.

Perlis and his team also gathered information about why respondents had low levels of trust. Participants with the two lowest levels of trust identified the following reasons: financial motives over patient care (35%), poor quality of care and negligence (27.5%), influence of external entities and agendas (13.5%), and discrimination and bias (4.5%).

“One of the most important parts of the study involved actually asking people why they indicated low levels of trust, in their own words,” Perlis explained. “What we found was that there were a number of common themes — but not all the same theme. Understanding that people develop mistrust of doctors and hospitals for multiple reasons is critical if we are to find a way to communicate with those people who have low trust.”

Results were also not fully accounted for by a general distrust in science, “suggesting some specificity for medicine per se,” the authors wrote.

On a brighter note, despite the decline in trust in physicians during the pandemic, “aggregate levels of trust were still substantial,” they noted. Of over 50,000 respondents who answered the survey during the spring and summer of 2023, a large majority said they had “some” (46.8%) or “a lot” (42%) of trust in physicians and hospitals.

By and large, physicians are well aware of the lack of public trust in healthcare systems, but there are no quick fixes. Building Trust, an initiative of the American Board of Internal Medicine (ABIM), formed in 2021, is one example of an organized effort to address the issue. The initiative urges clinicians to use the five C’s in their interactions with patients and other key stakeholders in the healthcare community — communication, caring, competency, comfort, and cost — to build and reinforce trusting relationships.

The study analyzed 582,634 responses from 443,455 unique respondents to online surveys offered by multiple recruitment vendors. Surveys were conducted every 1 to 2 months from April 2020 through January 2024 for a total of 24 waves.

Survey participants were asked, “How much do you trust the following people and organizations to do what is right? — Hospitals and doctors,” with four possible answers: “a lot,” “some,” “not too much,” or “not at all.” Participants were asked a similar question about scientists and researchers, and whether they had received the COVID-19 and influenza vaccines.

Respondents received incentives for survey participation, such as cash or gift cards, airline miles, vouchers, redeemable points, or entry into sweepstakes. Mean respondent age was 43.3 years, 65% were women, 71% were white, 11.1% were Black, 8.7% were Hispanic, and 5% were Asian American.

The study had a number of limitations, the authors pointed out. They used a single survey question to assess trust levels, precluding a more nuanced understanding. The survey also lacked a true panel design. Although respondents could return for more than one survey, most did not.

In addition, the study relied on nonprobability sampling methods, which may have yielded less representative samples. The survey was also only administered in English, which may have led to an undersampling of people with lower literacy or English proficiency. Finally, the researchers did not gather health-specific information on respondents.