Trust: The First Casualty of Transparency
Political and economic trends are sabotaging our trust in important institutions.
Trust has always been central to health care. We must trust doctors and hospitals if we are to benefit from the care they offer. Without trust, who would allow a surgeon to cut open their chest and fiddle with their heart? Without trust, who would take noxious medicines or suffer radiation burns for a disease whose symptoms they cannot detect? We patients don't know how these things work, but we are willing to place our lives in the hands of those who say they do and have licenses affirming it.
But public trust in medicine is eroding.
Why? After all, most of us are mostly insured and mostly healthy. So most of us are strangers to the perils likely to undermine the faith of frequent users of care: medical errors, hospital-acquired infections and eccentric health plan limitations.
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Jessie
Gruman
President
Center for the
Advancement of Health |
Health care delivery and payment systems haven't changed much over the years, but advances in technology promote increased transparency that may be tarnishing our idealized vision of them. For example, new evidence about what treatments are optimal leads to documentation of how infrequently they are delivered appropriately Similarly, the ability of researchers to examine the data underlying the new claims sensitizes us to incomplete data, inaccurate conclusions and biased researchers. Combining these with an active press corps, a 24-hour news cycle and the proliferation of watchdog groups creates an environment where we’re constantly reminded that health care professionals and institutions don’t merit our trust.
"That's the reality," you say. "This is why you have to be a vigilant health care consumer: health care is unreliable. You have to be careful; you have to become an expert; you have to question everything."
Jeepers. Really? Isn’t being sick already a full-time job? When I am sick, now I am also increasingly scared because I can’t do the due diligence required to feel safe.
Experts suggest big threats jar us into acting rationally. There is little evidence to support this notion. Even Alan Greenspan recently shared his shock at learning that individual people and individual institutions -- often don’t act on the basis of their long-term self-interest.
Declining trust in health care cannot be good: it leads us to devalue professional opinion and become more casual in adhering to recommendations. We begin to regard all information as equal; scientific claims bear the same weight as commercial claims and are regarded with suspicion or naïve enthusiasm, depending on what suits our fancy.
On the other hand, the erosion of trust yields a more realistic picture of what it takes to benefit from health care: we must learn when and how to test what we’re told and challenge our care.
Ultimately we will learn to accommodate this new reality. We will acquire a more accurate sense of what health care can do and what we must do. In the meantime, however, many of us are anxious and fear we are being asked to act far beyond our competence. And we aren't sure where to find reliable counsel.
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