Trust—it’s often said to be an essential component to survival. Borrowing from Stephen M. R. Covey, trust allows us to move and think with speed.¹ It allows us to have fulfilling relationships. It allows us to offer inspiration. It allows our economies to be profitable. And its power to influence the course of events—for whole societies or individually, and especially for our health and well-being—rests in the trustworthiness of the source. 

Some days it feels like the importance and challenges of trust have never been more on display than during these past 20 months.

Last May, several industry news outlets covered a study conducted by NORC at the University of Chicago and commissioned by the American Board of Internal Medicine Foundation as part of its new initiative to elevate trust to improve health care.^2,3 Those surveys, conducted from January through early February 2021, showed that the general public trusts doctors and nurses (84 and 85 percent, respectively) far more than hospitals (72 percent), the health care system as a whole (64 percent), or government agencies (56 percent); at the bottom of the list are pharmaceutical companies and health insurance companies (34 and 33 percent, respectively). They also showed that, while trust stayed the same or increased for most people, 32 percent said their trust in the health care system decreased during the pandemic.

This information comes as no surprise to emergency physicians. If anything, all signs point to even more erosion of trust since February. Through conversations with ACEP chapters where COVID-19 cases are again surging, it’s apparent that physicians’ feelings of physical fatigue are compounded by severe emotional fatigue. Each patient encounter has the potential to be derailed by a lack of trust in what the physician has recommended. Interpersonal support from friends and family may be challenged by opposing views on vaccines, masks, and mandates. Communities seem inspired more by the misinformation they believe rather than the motives of those they don’t trust—including the Centers for Disease Control and Prevention, the Food and Drug Administration, and even physicians. It’s so disheartening.

But here’s something we know for a fact: Patients do trust emergency physicians. ACEP recently commissioned Morning Consult to conduct a similarly sized poll among American adults, fielded between June 23 and July 7, 2021. Some highlights from the poll are shown at left.

More than nine in 10 adults trust an emergency physician to provide medical care in the ED. And they most trust a physician to lead care there, especially for more severe injuries and illnesses.

In a survey of 2,200 adults, we found that more than nine in 10 (93 percent) trust an emergency physician to provide medical care in the event they went to the emergency department. Those adults also consider 24-7 access to an emergency department to be just as essential to their communities as fire departments or water utility services. And they most trust a physician to lead care in the emergency department, especially for more severe injuries and illnesses.

In looking at ACEP’s Code of Ethics for Emergency Physicians, I can see why trust between patients and emergency physicians is so integral. Trustworthiness is one of the essential virtues of an emergency physician identified in our code: “Sick and vulnerable emergency patients are in a dependent relationship; they must rely on emergency physicians to protect their interests through competence, informed consent, truthfulness, and the maintenance of confidentiality.”

These are very difficult times. Lack of trust in health care systems is slowing your ability to act and think with speed. It is making it harder to offer inspiration and work as one. It is leaving many feeling that the systems designed to help are actually failing them.

But I don’t believe it is leaving us so empty that we can’t influence the course of events.

Read the rest of this blog post and link to the full poll results.

Ms. Sedory is executive director of ACEP.

References

1. Covey SMR, Merrill RR. The Speed of Trust: The One Thing that Changes Everything. ‎New York, NY: Simon & Schuster; 2006.
2. Public & physician trust in the U.S. health care system. Building Trust website. Accessed Sept. 16, 2021.
3. Reynolds KA. Who do patients trust? Medical Economics website. Accessed Sept. 16, 2021.