How to rebuild trust in our healthcare system

Felice J. Freyer’s May 8 article in the Boston Globe calls out that Americans’ trust in medicine is declining but that doctors can still turn it around. The piece focuses our attention on an often-overlooked critical issue - trust. To quote Dr. Andrew W. Bazemore (senior vice president of research and policy for the American Board of Family Medicine): “[Trust] is one of the most powerful tools of medicine, and if you don’t have it, no number of drugs, devices or other interventions are going to achieve much.”

So the decline in trust in healthcare is a major issue. In fact, I would go so far as to say that healthcare has lost its soul because trust is not a routine part of healthcare today. The article goes on to describe how TRUST is developed with patients. Dr. Katherine Gergen Barnett offers this description: “Trust is built in the context of human relationships…it is fostered by asking open-ended questions, staying curious about reasons behind the patient’s beliefs, and recognizing that a patient knows their body better than anyone else.”

So why isn’t trust a part of healthcare today? The reason is that healthcare’s billing and coding system cannot measure obtaining or seeking a patient's trust. If the insurer cannot measure something, they will not pay for it. It is hard to measure conversations. Doctors in today's intense world cannot afford to spend significant time on an activity that is not compensated. And by the way - building trust takes real time. I would go so far as to say that healthcare’s billing and coding system does not pay physicians to have conversations with patients - that is why patient visits have to be short. Just as bad is the fact that the billing and coding system does not pay physicians to talk to each other. Referrals today are simply a note in the chart. Referrals used to mean a physician personally discussing their patient to give context for the referral. That effort requires unpaid time for both physicians. One of the biggest problems in healthcare today is fragmented care - no one coordinates care. Why? Because coordination is very time-consuming and depends on conversation.

Until we change how we pay primary care physicians so they have time to build trust with patients and they have time to coordinate patient care, trust in medicine will continue to decline. Now there are physicians - a declining breed -- who do all these things without compensation but they are poorly paid and overworked. Physicians deserve to be paid for building trust with their patients. It would dramatically improve the quality of care and it would lower costs. To learn how to do it, go to www.thejourneys-end.org.