3 factors that erode your patients’ trust

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published June 21, 2022

Key Takeaways

  • Perceived discrimination based on race and ethnicity can lead to lower levels of trust in doctors among populations of color.

  • Both women and patients who exhibit negative health-related traits—including stress and low self-rated health—have proven less likely to trust in their physicians.

  • Doctors’ behavior on social media could affect their patients' trust in them. Consider how your content may affect relationships with your patients prior to posting it.

If you’ve ever stumbled upon the term medical mistrust, you may be aware of what it entails: Patients who don’t trust their HCPs and healthcare organizations to sincerely care about them and ethically treat them.

One harmful effect of medical mistrust is when patients who experience it avoid seeking healthcare.

Racial discrimination, certain individual patient characteristics, and social media presence among HCPs all may influence your patients’ ability to trust you—as well as their decision to work with you.[]

Discrimination—then and now

The trust that patients of color have in doctors takes a hard hit when discrimination surfaces in the doctor-patient dynamic.

As stated in an article published by The Commonwealth Fund, Black Americans have been subject to a long history of racist medical practices, including the Tuskegee syphilis study, forced sterilizations, and horrific experiments conducted on enslaved people.[]

This history has led to medical mistrust among Black Americans—so much so, that only 42% of individuals in this population reported a willingness to get the COVID-19 vaccine in 2021.

On top of historical racism, patients of color face difficulties participating in today's healthcare system. One basis for their hesitation is the fact that Black Americans are undertreated for pain compared with White patients.

One study showed that nearly 50% of medical residents believed falsehoods regarding the biological differences between White and Black patients (including the theory that Black patients have a higher pain tolerance than their White counterparts).

Trust can also vary among certain ethnic groups, as revealed by a BMC Women's Health study that looked at factors affecting levels of trust in healthcare among older Korean American women.[]

Researchers found that acculturation is associated with higher levels of trust in healthcare providers, whereas discrimination is associated with lower levels.

Mitigating instances of discrimination require HCPs to hone their professionalism and attain proper cultural competency training. This may require system-level policy changes to support culturally sensitive interventions for patients.

Another way to address racial discrimination in the workplace is by letting the patient be the expert of their own experience.

You can build trust with Black patients during pregnancy, for instance, by asking what they know about birth, what’s important to them about their birthing experience, what they need to feel safe, and other questions that allow them to guide their healthcare experience.

Patient characteristics

Another dimension of trust hinges on health-related traits in patients themselves.

According to a study published by BMC Primary Care, individuals who exhibit negative health-related traits, such as stress and low self-rated health, are less likely to trust in HCPs. []The same is true of women and individuals who fall under a lower income bracket.

This study’s 1,000 participants had a mean trust value in physicians of 3.3 on a five-point scale. The findings also showed that lower levels of trust in the healthcare system at large are linked to lower levels of trust in physicians.

Social media presence

Alongside social determinants of health and health-related traits in individual patients, the depth of your patients’ trust in you may be influenced by your presence on social media.

A survey published by AJOB Empirical Bioethics found that patient trust in physicians decreases when physicians post harmful content online.[]

This could include racially discriminatory comments, profanity, posts that portray the physician as intoxicated, and disrespectful stories about patient experiences.

While further research is needed to come to any formal conclusions about the link between social media use and patient trust, doctors are advised to consider how their social media content could affect patient relationships before posting.

What this means for you

Medical mistrust can cause patients to avoid seeking needed care. Doctors who racially discriminate tend to be trusted less by patients they harm. Doctors should be aware that female patients, smokers, highly stressed individuals, and those who feel they have poor health can perceive that physicians discriminate against them. Affect patient trust by posting online and maintaining a social media presence—but consider how your posts may influence their perception of you before posting.

Read Next: What to do when your patient doesn't trust you
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