In many ways, the term “medical mistrust” blames communities subjected daily to racism and disenfranchisement. Instead, the blame must be placed squarely on the shoulders of the institutions whose biased practices and “efficiencies” undermine patient experience and disregard patient perspective.
Laura Bogart, a social scientist who examined the impacts of medical mistrust in HIV care, defines medical mistrust as “an absence of trust that health care providers and organizations genuinely care for patients’ interests, are honest, practice confidentiality, and have the competence to produce the best possible results.”
Interestingly enough, patients may trust their own doctor, but not the institution of medicine, the pharmaceutical industry or the supporting framework. Being skeptical protects people from being subjected to medical guidance that does not include their perspectives, needs, or cultural norms.
As a physician, the CEO of a health system in Houston, and a Black woman, I experience the polar draws of caring for people, being attuned to the financial bottom line, and countering the bias that exists even in my own institution. Dismantling bias takes intentional work. The work is hard but necessary and is the first step in short circuiting so-called medical mistrust.
It is no wonder that folks don’t trust the medical establishment. How often do doctors talk at patients instead of to them. They forget that the patient’s expertise is knowing their own body – how it feels when things are “off,” what it feels like to be healthy and strong, and what side effects from medication they are willing to tolerate.
The medical establishment should stop paying lip- service to patient-centered care and shared decision-making and do the work to cultivate trust. This means providers must share the clinical evidence instead of assuming patients won’t get it. Patients must ask questions when things are not clear and demand explanation.
The power dynamic between clinicians and patients creates a space where the clinician dominates the equation. It is important as a clinician to actively short-circuit that power dynamic. Allowing the patient to have input, share their preferences and drive pace of care plan does not take anything away from my medical expertise. It actually enhances the care I provide.
From time to time, I am asked by colleagues how to dismantle medical mistrust. My recipe is to remind them that trust flows in both directions. Why should we expect trust from someone we don’t in turn trust. Act with transparency – state clearly what you know, what you don’t know and what you will do to figure it out. Recognize that we don’t change people, we change ourselves.
Dismantling medical mistrust is not something we do to the community. It is something we learn from the community. As we listen to the wisdom of our patients and consider their contexts, medical mistrust will dissolve.
Dr. Charlene Flash is president and CEO of Avenue 360 Health and Wellness. She is an Assistant Professor at Baylor College of Medicine and an Associate Professor at the University of Houston College of Medicine.