Trust and Healing in the Era of Low Trust

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Photo by Kristin De Soto on

Trust is Down Globally

For the past 18 years, the Edelman Group has conducted an annual global survey called the “Trust Barometer” which looks at levels of trust in institutions. They report on findings in the general online population 18 years or older, and they reflect on seven years of data in over 25 markets. Edelman frames 2018 as “The Battle for Truth,” whereas 2017 was “Trust in Crisis.”

In the era of “fake news,” an overused term, what happens to society when people lose trust? What are the long-term implications? Globally, the biggest losses in trust are seen in institutions like the government, media, business, and Non-Government Organizations (NGOs), and were experienced in the United States, Italy, Brazil, India, and Colombia, while gains were seen in China, South Korea, and the United Arab Emirates. Globally, the weaponization of “fake news” looms large with 70% of respondents expressing concern about the nefarious forces that may shape the global political landscape. Countries like Singapore are enacting laws to counteract “fake news,” and Germany has passed laws that penalize social media companies for failing to address the presence of “fake news.” The challenging aspect here is that media as an institution is now the least trusted. Media includes social platforms, news apps, publishers, and search engines. With a five-point increase from the 2012 to 2018 measurement cycle, one glimmer of hope shows trust in journalism is returning. Trust in health care has remained stable for the past three years and sits at 64%.

Why is Trust Important in Health Care?

In 2002, Dr. Susan Dorr Goold from the Center for Bioethics and Social Sciences for Medicine at Ann Arbor (MI) penned an editorial in the Journal of General Internal Medicine, addressing the importance of trust in health care delivery. Receiving health care can be a unique experience; think about the last time you didn’t feel right and went to see your doctor. Likely you were anxious and vulnerable as, unless you too are a doctor, you are putting your trust in someone who has more specialized knowledge than you. This imbalance means that to trust your care provider is paramount. Tools that measure trust have been growing at a health plan level and also at the individual doctor level, so it is a concept that is getting more attention. Does a higher level of trust in your doctor improve health outcomes? This question was posed by Johanna Birkhaeuer and colleagues from the University of Basel, Switzerland, who conducted a meta-analysis, a study of studies, to explore the relationship between trust and health outcomes. They published their findings in PLOS one in 2017, and a total of 47 reviews were included in the analysis. Results show a modest correlation between trust and outcomes; a weaker association was found for health behaviors, quality of life and severity of symptoms. Birkhaeuer and colleagues caution the findings, as the study had some limitations: they advise the results could have been overestimated, as they weren’t able to parse out potential moderators for trust. They also suggest that more prospective studies need to be conducted to decant how trust impacts health outcomes.

In my own experience, conducting video ethnography with patients who are seeking care for mental health, pain management or hypertension, all reflect the importance of trust in their care team as they navigate the complexity of receiving care and managing illness. Often, your care provider may be the only person to know your health history, and many patients share information that they would not share with family or friends. In a world where trust has eroded significantly, continuing to build trust in healing relationships remains essential.

Thanks for reading- Trina

(My opinions are my own)



Edelman Trust Barometer 2018

Trust, Distrust, and Trustworthiness

Click to access jgi_11132.pdf

Trust and Health Outcomes

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