Restoring Public Trust In Doctors
People no longer trust their doctors. In addition to survey evidence, there is increasing violence against healthcare workers, worsening burnout of doctors and nurses, and accelerating erosion of the caregiving workforce.
Restoring trust starts with determining why it was lost. There are at least seven reasons: lack of choice (loss of freedom), affordability, depersonalization, accessibility, outcomes, CoViD, and system frustration. Only by fixing the root causes might people’s faith in their physicians be restored.
Patients do not have faith in doctors they do not choose for themselves but who were instead assigned to them by faceless, unaccountable health plan bureaucrats based on low-bid contracts. If patients could choose their own care providers, they could have faith that “their” physicians actually worked for and were dedicated to them.
Medical care is currently unaffordable (e.g., $2850 for an MRI, $1000 for a vial of insulin, and $5000-$10,000 per day in an ICU). The public believes doctors are responsible for unaffordable high costs with their exorbitant salaries, unnecessary tests and procedures, and elaborate fraudulent schemes. In reality, medical care would become readily affordable if patients had control of their own healthcare spending. Instead, insurance companies and the federal government, after first taking half of all healthcare spending for themselves, offer physicians the leftovers as non-negotiable payments.
Patients complain bitterly about depersonalization, and rightly so! My doctor doesn’t know me as an individual. My doctor spends more time on the computer than with me. Between the enormous government regulatory burden and time-consuming hospital and insurance administrative obligations, physicians have too little time to talk to, examine, or simply be with patients. The solution is obvious: eliminate the regulatory and administrative burdens so care providers can do what patients expect and what the providers want to do and were trained to do: care for patients.
Image: Doctor and patient by pressfoto.
After unaffordability, inaccessibility is another compelling reason for distrust. What good is an assigned physician if I can’t get to see the doctor? Before the Affordable Care Act (ACA, 2010), the maximum average wait time to see a primary care physician was 99 days. After ACA went into effect, wait time increased to 122 days, causing death-by-queue. Cutting wait times requires reinserting free market forces into healthcare so that clinicians are incentivized to provide timely service and can afford to do so.
The U.S. appears to have inferior health outcomes—longevity, infant mortality, and complications of diabetes—when compared to other nations. The public blames doctors, but these metrics have little to do with what physicians do. Longevity is influenced mainly by genetics and lifestyle. High infant mortality is often related to illicit drug usage. Infant mortality statistics are also gamed as America is one of the few countries that counts all live births. Others count only infants likely to survive. America is also the most obese nation on earth, leading to high incidences of type 2 diabetes and manifold expensive complications. When it comes to these metrics, patients’ health is primarily in patients’ hands, not physicians’.
CoViD was the final straw that broke the proverbial camel’s back. Any sliver of remaining public trust was washed away by how federal, state, and local governments handled their ginned-up pandemic. Governments across America abrogated the First Amendment (free speech, assembly, religious practice), blamed people for a “pandemic of the unvaccinated,” enacted lockdowns, prohibited useful treatments like Ivermectin, and, with help from many doctors, pushed experimental mRNA gene therapy (so-called CoViD vaccines) that did not have appropriate testing before release and were dangerous to the majority who acceded to Fauci’s mandatory “jab.”
Some doctors enthusiastically embraced the jab but many had no choice. Those who did not want to administer mRNA gene therapy were threatened with loss of hospital privileges or licensure. Hospitals would not treat or even provide transplants to unvaccinated patients. Healthcare workers who refused the shots were fired. Clinicians were coerced with these threats, and information countering the official narrative was suppressed.
CoViD exposed a medical tyranny that Americans deeply resented. The public tends to focus blame on the point of contact: the person giving the shot. In reality, the tyrannical mandates came from federal bureaucrat MDs like Fauci, Walensky, and Collins, not from frontline, practicing, in-the-office physicians who were forced to give the shots.
Finally, Americans are exceedingly frustrated with a healthcare system that is impossibly complex, contradictory, and constantly changing. Thus, they are angry at and distrustful of the people they think are responsible: doctors.
Healthcare is so convoluted that ACA had to create a whole new category of bureaucrats: navigators. Where did the money come from to pay navigators? From payments to doctors and nurses. Such bureaucratic diversion of healthcare funds leaves too little money to pay for timely medical care. Patients cannot take out their frustration on an amorphous system. They focus on the person before them: the doctor.
The common thread behind the public’s mistrust of doctors is third-party decision-making, whether by the government or insurance companies. To restore trust, we must return decision-making authority—both financial and medical—where it belongs: to patients.
If we eliminate third-party control, free market forces will return to healthcare. Patients-as-payers will have a powerful incentive to economize, which reduces spending. Sellers of care, both individuals and institutions, would have powerful incentives to provide timely, quality, personalized care while keeping prices low. In a free market, those who fail to deliver affordable, compassionate care would quickly find their waiting rooms empty.
Add state-based safety nets for the medically vulnerable, and Americans would once again begin to trust doctors.
Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.