Americans' trust in doctors, hospitals plunged during pandemic, survey suggests

Skeptical man looking at phone

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Trust in US physicians and hospitals fell from 71% to 40% during the COVID-19 pandemic in across sociodemographic groups, a Massachusetts General Hospital (MGH)–led survey study suggests.

For the study, the scientists parsed data from 24 waves of an online nonprobability survey fielded to US adults in all 50 states from April 2020 to January 2024. The survey asked about trust in physicians and hospitals, as well as COVID-19 and influenza vaccination status. Respondents were offered incentives such as cash, airline miles, gift cards, or vouchers

The unweighted average participant age was 43.3 years, 65.0% were women, 71.1% were White, 11.1% were Black, 8.7% were Hispanic, 5.0% were Asian-American, 2.2% were of other races, 1.3% were Pacific Islander, and 0.7% were Native American.

The findings were posted today in JAMA Network Open.

"Trust in physicians and hospitals has been associated with achieving public health goals, but the increasing politicization of public health policies during the COVID-19 pandemic may have adversely affected such trust," the researchers wrote.

Erosion seen across socioeconomic groups

Among the 582,634 survey responses from 443,455 unique adults, trust in doctors and hospitals plummeted from 71.5% to 40.1% across socioeconomic groups over the study period. Adults who reported lower levels of trust were less likely to have received COVID-19 vaccines or boosters.

Effective interventions aimed at restoring trust could have benefits, not only for future pandemics, but for health in the US more generally, at least in terms of vaccination.

Regression models tied lower trust as of spring and summer 2023 with ages 25 to 64 years, female sex, lower educational attainment, lower income, Black race, and urban residence, even after controlling for political affiliation.

Higher levels of trust were linked to a greater odds of COVID-19 vaccination (adjusted odds ratio [aOR], 4.94), flu vaccination (aOR, 5.09), and receipt of a COVID-19 booster dose (aOR, 3.62).

Responses from the 200 adults with the two lowest levels of trust indicated perceptions of financial motives over patient care (35.0%), poor quality of care and negligence (27.5%), other (19.5%), influence of external entities and agendas (13.5%), and discrimination and bias (4.5%).

Possible long-term public-health effects

The researchers said the observational study couldn't determine the cause of the trust erosion. But they said that, when considered in the context of previous studies with similar results, the study "raises the possibility that the decrease in trust during the pandemic could have long-lasting public health implications. If so, effective interventions aimed at restoring trust could have benefits, not only for future pandemics, but for health in the US more generally, at least in terms of vaccination."

One possible reason for low trust may be physician financial conflicts of interest, a factor that may have been aggravated during the pandemic, the researchers said.

"A better understanding of groups exhibiting particularly low trust, and the factors associated with that diminished trust, may be valuable in guiding future intervention development and deployment," they wrote. "However, a prior [pre-COVID] Cochrane review concluded that there was a lack of evidence that any intervention meaningfully changed trust in physicians, despite a number of efforts to do so that observed generally modest effects."

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