A Health Advocate's Perspective

In my four decades in the healthcare field, I've witnessed the evolving dynamics of the doctor-patient relationship. Today, trust between patients and physicians is under strain, influenced by systemic challenges and shifting expectations. However, by understanding our roles and fostering open communication, we can mend and strengthen this vital bond.

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The Erosion of Trust: Understanding the Landscape

Recent studies highlight a decline in public trust toward physicians. A 2024 survey revealed that trust in physicians and hospitals decreased from 71.5% in April 2020 to 40.1% in January 2024. Factors contributing to this erosion include brief consultations, perceived lack of empathy, the COVID-19 pandemic, and the influence of insurance and pharmaceutical companies.​

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Physicians, too, are feeling the pressure. Burnout, characterized by emotional exhaustion and reduced personal accomplishment, affects many doctors, impairing their ability to provide quality care and impacting patient interactions. Recognizing these challenges is the first step toward rebuilding trust.

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What Happens When Patients Stop Trusting Their Physicians?

Trust in physicians and the healthcare system is very important in sustaining or improving public health as well as helping to promote patient’s compliance with things like preventive care, vaccinations, healthy diet, smoking cessation, etc., As people begin to lose faith in their doctors and the healthcare system, they also begin to distrust messages related to healthcare, which we see evidence of on a daily basis in the ongoing debate over whether vaccines are good or bad, which ones are ok or not ok, with significant conflicting information appearing in supposedly reliable sources every day stated as fact. Disinformation and outdated information are rampant and/or misleading, but it is so hard to tell which is which. Asking your physician about what is best for you should be the “go-to” for all of us because that person should know the most about our individual health history and what is available out there. And if you are not sure about that relationship, then finding another one, or at least getting a second opinion, is imperative.

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Optimizing the Physician-Patient Relationship

Embrace Shared Responsibility

A successful healthcare journey is a partnership. Patients have responsibilities too which include:​

• Prepare for Appointments: List symptoms, concerns, and questions beforehand, which means write them down so you do not forget.​ This allows you and your provider to make the best use of the available time and make sure you get the information you need!
• Be Honest: Share all relevant information, even if it feels uncomfortable.​ Your provider cannot possibly give you the best, most valid response without knowing all of the information.
• Follow Through: Adhere to agreed-upon treatment plans and communicate any challenges. Lack of patient compliance is one of the biggest areas that prevent successful outcomes in health. In order to comply, however, you have to understand what you are supposed to do, so make sure you ask any questions you may have.
• Bring someone with you if you can: If at all possible, please bring someone with you to help take notes, listen, and ask any questions if things are not clear. I do this myself because we all stop hearing everything when we have complex or scary medical conditions. If no one can come with you, ask if you can record the conversation on your cell phone so that you can play it back later when you can’t remember everything. Most providers will agree when asked this way.
• Understand that YOU have a seat at the table and need to be a part of the decision on what comes next: Ask what the alternatives are and the pros and cons of each. Discussion about the alternatives is called shared decision making, and as that label implies, you have a part in the decision.

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Physicians, in turn, should strive to listen actively, provide clear explanations, and involve patients in decision-making.​

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Acknowledge Physician Stressors

Understanding the pressures doctors face—such as administrative burdens and time constraints—can foster empathy. While this doesn't excuse subpar care, it provides context. Open dialogues about these challenges can lead to mutual respect and better collaboration. Physicians may not set the time limits on appointments…these may be set for them. But you still have the right, as a patient, to get all of your questions answered as long as you do your part too and come prepared to the appointment!

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Hold Physicians Accountable Respectfully

If concerns arise:​

• Communicate Directly: Address issues promptly and calmly.
• Seek Clarification: Ask for explanations about diagnoses or treatments.​‍
• Request Second Opinions: It's your right to seek additional perspectives when uncertain.​ If there is the possibility of a proposed treatment or procedure under discussion, a second opinion should be seriously considered. If your doctor resists the idea, then that is not someone you should be working with. These days, you can typically obtain a second opinion by submitting your medical history, including lab results and images, and then following up with a video conference call. You rarely have to see the doctor providing the second opinion in person, so travel expense is not an issue. Insurance will usually cover second opinions.

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Initiatives like "Martha's Rule" in the United Kingdom empower patients to request second opinions, emphasizing the importance of patient advocacy in care decisions. ​In the United States, second opinions have also become very common.

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Navigating Healthcare Roles: Who Does What?

Understanding the qualifications and scopes of various healthcare professionals can clarify expectations.​ Have you ever wondered why, when you go to your “doctor’s” office, you sometimes see your doctor but often see someone else, such as an APRN or a PA? That is not necessarily a bad thing. These days, there are frequently either shortages of providers, especially in certain specialties and/or regions of the country, or efforts to try to optimize how we use the time of physicians vs. other allied health providers. MDs and DOs have more training and are especially suited to complex cases, anything that requires surgery or may cross specialties. If you are being seen in a practice that has both MDs/DOs and some type of APRN or PA you would want to be seen by the MD or DO at regular intervals but unless your have an unusual case, you may be able to get in to see the APRN more frequently and in fact get excellent very personal care. Here are some more specifics regarding the differences in training and scopes of practice:

• MD (Medical Doctor): Completes medical school and residency, sometimes even fellowships in specific areas of practice; practices allopathic medicine, which is what we think of as Western medicine.
• DO (Doctor of Osteopathic Medicine): Similar to MDs but with additional training in holistic care and osteopathic manipulative treatment.​ In most hospitals and practices in the United States, MDs and DOs are interchangeable, though DOs have a more holistic orientation.
• PA (Physician Assistant): Medical professionals trained to diagnose and treat illnesses under physician supervision.​‍
• APRN (Advanced Practice Registered Nurse): This is an umbrella category that includes a wide range of nurses with advanced education and clinical training. It includes NPs (see below) and other specialized nurses with advanced clinical training, such as Certified Registered Nurse Anesthetists and Certified Nurse Midwives. Some people choose to call themselves APRNs. They are licensed to diagnose and to prescribe medication.
• NP (Nurse Practitioner): A subcategory of APRN, often with specialties and certifications in given areas such as adult-gerontology, pediatrics, psychiatric-mental health, etc. NPs can diagnose and treat illnesses, often focusing on patient education and preventive care.​ NPs are able to prescribe medication in all 50 states. In some cases, especially primary care and psych, they may practice on their own without an MD or DO, especially when there is a shortage of physicians in that area. If additional expertise is needed for complex cases, they will consult with appropriate physicians or refer their patients.
• DNP (Doctor of Nursing Practice): APRN or NP with a doctoral degree emphasizing clinical practice.​
• MA (Medical Assistant): Supports physicians with administrative and basic clinical tasks.​
• DC (Doctor of Chiropractic): DCs undergo more extensive training than many people realize. These days, they have to have a 4-year undergrad degree and then attend a 4-year broad and comprehensive accredited Doctor of Chiropractic Degree program, followed by an internship, board exams, obtaining a state license just like a physician. They also have continuing education requirements, as is customary for most healthcare professions. In their practices, they frequently coordinate closely with orthopedists, neurologists, and physical therapists, along with other health professionals.
• ND/NMD (Naturopathic Doctor): Focuses on natural remedies and holistic care; training and licensure, which includes a 4-year accredited graduate-level program, including ability to order lab tests and prescribe medication, which varies by state.​ In some states, an ND may practice jointly with an MD or OD in order to be able to prescribe medications. This is often seen in integrative medicine practices in particular. NDs are not licensed or regulated in all states and may not have completed the rigorous accredited training, continuing education, and licensure requirements. It is important to know what is required in your state.

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Choosing the right provider depends on your specific health needs. It can be a challenge to make sure that you feel that your care needs are being met. Some people feel that the NP in their doctor’s practice listens better and is more responsive. Others feel neglected because they are not seeing “the real doctor.” If you feel that you need to see the physician associated with your practice and that your NP or PA is not addressing all of your concerns, speak up and ask for an appointment with that doctor or ask that the doctor step in for a few minutes. This is one of the things that I do for my clients on a regular basis, especially if I feel that they need a greater level of expertise that a physician might bring because of the complexity of their situation. Remember, you have a voice in your own care!

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Rebuilding Trust: A Collaborative Effort

Trust is the cornerstone of effective healthcare. By embracing shared responsibility, understanding each other's challenges, and fostering open communication, patients and physicians can rebuild a relationship grounded in mutual respect and collaboration.​ In other words, we all have a part in making these relationships viable and valuable. As a health care advocate, I encourage patients to be proactive, informed, and compassionate partners in their healthcare journeys. Together, we can navigate the complexities of the medical system and work toward positive outcomes for all.

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Wishing everyone good health and healthcare,

-Lee

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SOURCES

MDU

National Library of Medicine

National Library of Medicine

National Library of Medicine

The Guardian

KKF

Medical Economics

The Lancet Digital Health

Patient Association