Strengthening Patient Trust in Physicians and Health Systems with Dr. Rich Baron | AMA Update Video

AMA Update covers a range of healthcare topics affecting the lives of physicians, residents, medical students and patients. From private practices and health system leaders to scientists and public health officials, hear from medical experts about COVID-19, monkeypox, medical education, advocacy issues, burnout, vaccines, and more.


In today’s AMA Update, Rich Baron, MD, president and CEO of the American Board of Internal Medicine and the ABIM Foundation, joins the discussion on the importance of rebuilding trust in the health care system. Hosted by AMA Chief Experience Officer Todd Unger.

For more information, visit BuildingTrust.org.

Speaker

  • Rich Baron, MD, President and CEO, American Board of Internal Medicine and ABIM Foundation

Unger: Hello and welcome to the AMA Update video and podcast, an ongoing series covering a range of health care topics that affect the lives of physicians and patients. I’m Todd Unger, Chief Experience Officer at the AMA in Chicago, and today we’re discussing how to combat mistrust in the health care system and the spread of misinformation.

I’m joined by Dr. Rich Baron, President and CEO of the American Board of Internal Medicine and the ABIM Foundation. Dr. Baron, welcome.

Dr. Baron: Great to be here Todd with you and my fellow AMAs.

Unger: Well, thank you again for talking to us about something really important and certainly at the heart of the pandemic, which is misinformation and mistrust of our health care system. It seems to be at an all-time high right now. We have public skepticism about COVID and the vaccine as a prime example of this.

Your organization, the ABIM Foundation, is committed to rebuilding this lost trust with the Trust Building Initiative. Tell us more about the purpose and goals of your initiatives and how you seek to achieve them.

Dr. Baron: Well first of all, for anyone who wants to learn more about this, you can go to buildingtrust.org and there we have a description of the initiative and a compendium of some of the results. But I would say the most important part of this is to recognize — sometimes I describe us as being in the Paul River phase of a trust-building initiative.

I think many of us in healthcare think we have credibility because we mean well. And frankly, it’s not news to your viewers that the American Board of Internal Medicine has lost the confidence of many of our diplomats. And we assumed, oh, we have this. We have the right intention. We have the right people. We have qualified people. Why do people not trust us?

And people did. And that was because we had neglected the relationship with the doctors we served. And we had assumed that of course they thought we were on the right side and of course they thought we had their best interests at heart. And it turned out that we failed organizationally to build the relationships we needed to build to be successful.

And part of the way that the ABIM Foundation decided to go in that direction was that we realized that ABIM was not the only one in the healthcare universe that believed that because we had the experience, because we had the experts, because we had the science, of course , people will trust us. And in fact, science and expertise are not enough, they are not enough.

Unger: So going back to your Paul River example, you beat that worry. Are you saying that there is a difference between how doctors perceive themselves and their relationships with patients in terms of this level of trust?

Dr. Baron: Absolutely. And what we’re interested in is engaging with people in healthcare who prioritize building trust as a strategy to achieve their core strategic goals. So people have conversations in organizations all the time. How to increase market share? How do we increase, or at least generate, a variety of organizational activities in service of this goal?

Well, what does it look like when the organization says, how do we build trust? And in the case of healthcare organizations, I think that during the pandemic many of them lost confidence in the doctors who work in them, serve them. And it was everything from whether they successfully provided PPE, what expectations they had during the pandemic, how well they protected people, how well they connected with the stress and strain that people were under.

These were many opportunities where people lost confidence. So building organizations of trust between their physicians, organizations with their communities, and physicians with the patients we serve. And what we do at buildingtrust.org is invite people in different ways to engage in local trust-building practices within their contexts, and then do what we can to elevate that.

So we have a few broad strategies. One of these is the challenges of trust practices within institutions, where the institutional leadership invites everyone in the institution to advance what they consider to be a trust-building practice. And that can be recognized and paraded in front of the whole group saying, look, this is really important to us. This is valuable.

So we did some of that and some of the examples of that are on our website. And we have different ways that institutions can get involved and examples on the website of paths that people can take.

Unger: Well, Dr. Baron, let’s talk about some specific changes that doctors and health systems can make to restore trust in the health care system. You have a frame. I think it’s called the five C’s. Tell us what they are and how they apply here.

Dr. Baron: true So we really think that people can organize work by building trust around the five Cs, the Cs being care, comfort, competence, communication and cost. Addressing these things in a holistic way can help organizations organize activities in ways that are likely to build trust. And each of us, we know that in our daily clinical opportunities, we have opportunities to build all of this. They are all opportunities where we can do better.

Unger: Now you talked about different, I would call it a relationship in terms of trust. You talked about the patients’ doctors. You talked about physician systems. One thing we haven’t talked about much is trust between doctors, which can also be improved. We generally don’t talk about it. Is this something you find important? And how do physicians improve trust in their own peer group?

Dr. Baron: Great question. And that’s absolutely important—we have all kinds of literature, for example, that malpractice lawsuits often start when the doctor the patient is seeing says, I can’t believe the other doctor did that. And I think recognizing that we work in teams and do what we can to establish the credentials…

One of the trust practices we learned about was in an emergency room, shift or shift, the emergency room doctor would say, “Oh, Dr. Eddie-who is coming after me. She is great. You’re really lucky to have her.” And that sets the stage, makes the patient feel that there’s continuity, that good things are going to happen.

So building trust between doctors is largely about respect and mutual recognition of competence. Communication helps a lot with this. When patients see a doctor and that doctor has no idea what the other doctors they’ve seen have said or done, it really destroys trust. And when there is good communication between doctors, it builds trust. “Oh Dr. Jones told me your daughter is getting married next weekend. Congratulations.”

So there are different options we can have to build trust between colleagues that follow the same principles, but also often involve showing patients in a way that respects colleagues.

Unger: Well, one last question. Building trust is obviously a big deal. How do you know if you’ve achieved your goal? What are the markers along the way that you are succeeding?

Dr. Baron: Well, firstly, the level of institutional commitment in trying to make this happen is an indicator. I really think a lot of healthcare institutions believe, well, we’ve got this. We don’t have to work on it. And so one marker is simply the sheer commitment and volume of institutions willing to devote some managerial bandwidth and organizational focus to building trust.

We then work with Academy Health to develop trust measures. Some work that was done on this early part of the research work on the constraint and there are ways to measure confidence. We would like organizations to commit to measuring and improving trust. And there’s strong evidence of — there’s strong evidence of how improving trust improves clinical outcomes.

And that’s all we have in the COVID immunization data is that people who don’t trust institutions in the health care delivery system are much less likely to get vaccinated and therefore at much higher risk of the severe consequences of this disease. So there is a lot of evidence that the degree of confidence that people have has an impact on the clinical outcomes that they have.

And one more point on that. Lancet study looks at COVID outcomes internationally – The World Health Organization has developed a post-Ebola Pandemic Preparedness Index, which is a set of structural measures of how well countries are prepared to respond to the pandemic. The Pandemic Preparedness Index was found to not predict mortality from COVID.

The biggest predictor of COVID mortality internationally was the level of trust people had in their government, and even more powerfully, the level of trust people had in their fellow citizens. And the authors of that report noted that if the United States had achieved the levels of confidence that Denmark had, which was at the 75th percentile, almost a third of the deaths from COVID would not have occurred.

Unger: Well, that’s something that we really have to think about, it points to the challenge that we have before us. For more information on the ABIM Foundation’s Building Trust initiative, visit their website at buildingtrust.org. We’ll be back soon with another AMA update. Thank you very much, Dr. Barron, for being with us today. You can find all of our podcasts and videos at ama-assn.org/podcasts. Thanks for joining us. Please take care.


Disclaimer: The views expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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