Americans' trust in medicine is declining. But doctors can still turn it around.

Boston Globe

08-05-2025

Indignant, Harding sensed that her providers saw her as a stereotype — an elderly Black woman they wrongly assumed was poor and neglectful of her health — and so they did not look deeply into her complaints. Fed up, two years ago she wrote letters to each of her doctors, firing them. They had lost her trust.
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By any measure, such scenarios are a huge loss for patients and doctors — and data suggest that a growing number of Americans experience them.
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Dr. Andrew W. Bazemore likens trust to a new drug or device. 'It's one of the most powerful tools of medicine, frankly, and if you don't have it, no number of drugs, devices, or other interventions are going to achieve much,' says Bazemore, a primary care doctor in Virginia who is senior vice president of research and policy for the American Board of Family Medicine.
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Research backs up his assertion. When patients trust their health care provider, they experience fewer symptoms, a higher quality of life, and more satisfaction with treatment, according to a review of 47 studies published in 2017.
But now, Bazemore says, trust in medicine is 'under siege.'
A strained medical system often fails to provide attentive care — as doctors burn out, patients struggle to get appointments , and costs keep rising. Social media influencers are peddling useless or dangerous remedies, and the anti-vaccine movement is gaining traction, even amid a measles outbreak that has already led to more than 880 confirmed cases in the United States this year. Meanwhile, the nation's secretary of health and human services, Robert F. Kennedy Jr., has been sowing doubts and spreading falsehoods about vaccines.
Trust in doctors, in state and local public health officials, and in key federal health agencies declined by roughly 10 percentage points from 2023 to 2025, according to the Kaiser Family Foundation.
Changes in federal leadership are making people less trustful of recommendations from agencies that once were guiding lights for doctors and patients alike. According to a March
Notably, though, the Kaiser Family Foundation poll found that, even as trust declines overall, doctors remain by far the most trusted. Some 85 percent of respondents said they have a great deal or a fair amount of trust in their doctors, down from 93 percent in 2023.
A trusted doctor's advice, given in the privacy of the exam room, may be the sturdiest bulwark against misinformation. But that relationship can also be precarious.
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Dr. Andrea Reilly, a primary care doctor in Boston, remembers the exact moment she lost the trust of a patient's family.
Reilly described the troubling encounter in an essay,
Harvard Medicine
magazine. At the end of a long, complex visit with a teen patient and her mother, amid calls from the reception desk saying two patients were waiting, Reilly told the mother that her daughter was due for vaccines.
When the mother balked, saying she wanted to do her own research, Reilly blurted out, 'Don't you trust me?'
'As soon as the words left my lips,' Reilly wrote, 'I knew I had said too much.'
Three days later the mother called the office to say the family would be seeking care elsewhere.
Reilly wishes she had handled the exchange differently. But in an interview, she admits that the mother's suspicions about her professional credibility had hurt her feelings. 'We're trying to get it right,' she says. 'I really want to help you — I don't have another agenda.'
Reilly says she appreciates it when patients bring her their research so she can go over it with them. But some just drop off a stack of studies, expecting it to overrule her years of training and experience. 'It's an insult in some ways,' she says.
Today, credentials, smarts, and good intentions are often not enough. A more complex and open-minded relationship must be nurtured.
'Trust is built in the context of human relationships,' says Dr. Katherine Gergen Barnett, a family medicine doctor at Boston Medical Center. It can be fostered by asking open-ended questions, staying curious about the reasons behind the patient's beliefs, and 'recognizing that a patient knows their body better than anybody else in the world,' says Gergen Barnett, who is a vice chair of primary care innovation and transformation at BMC and a Boston University associate professor. Clinicians, she says, need to give back to patients 'that power to be in charge of their health.'
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At the height of the COVID-19 pandemic, Gergen Barnett cared for an immunocompromised patient and her elderly mother — exactly the profile of patients most likely to die from COVID. But they didn't want the vaccine, worried that it had been derived from human embryos.
'It took multiple visits where I sat with them, I talked to them, I heard their concerns, I told them my concerns. And they prayed on it,' Gergen Barnett recalls. The patients ultimately decided to get vaccinated, telling her they appreciated her willingness to listen.
Dr. Katherine Gergen Barnett at Boston Medical Center.
Lane Turner/Globe Staff
Gergen Barnett is a white doctor who works with the diverse population at BMC — about 70 percent of patients there identify as people of color, a group that research shows is more likely to distrust doctors and hospitals. In Massachusetts, trust levels among commercially insured Black, Asian, and Hispanic people consistently fall several points below those of white people, according to
Dr. Oni Blackstock, a primary care doctor who led New York City's effort to end the HIV epidemic, recalls that in the early days of AIDS, some patients believed the virus was created by the government to kill Black and gay people. She sees many parallels with the response to COVID-19 vaccines. One of her HIV patients resisted vaccination for COVID even after two family members had died of the disease. He was unnerved by how quickly the vaccine had been developed. 'It makes me think about Tuskegee and whether they're testing this on us,' he told her.
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People such as Cheryl Harding, who felt dismissed and unseen.
Or the Rev. Irene Monroe, a well-known Boston theologian, activist, and podcaster, who recalls with still-raw outrage how a doctor once expressed surprise at her sophisticated vocabulary.
Or any Black person who gets lower levels of pain medication or waits longer for test results than their white peers.
The question, Blackstock says, is not whether Black people have enough trust, but whether the institutions and providers they encounter are trustworthy. As doctors, she says, 'It's really incumbent on us to build that trust.'
Sylvie Leotin, a Black woman and immigrant from France, isn't sure whether race was a factor in a medical ordeal she experienced in 2017. But it certainly destroyed her trust.
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Leotin, who now lives in California, was undergoing an MRI-guided core biopsy to detect breast cancer, which she was told would be minimally invasive. Instead, for an hour she lay face down in the MRI machine, while the doctor working underneath her jabbed her many times with a 'biopsy gun,' trying and failing to extract cells from the targeted area. He never asked how she was holding up, or even talked to her. Speechless with pain and confusion, all she could do was wait 'for the torture to end.'
In her view, the doctor had completely forgotten that she was a human being.
Leotin was told that she didn't have cancer. But months later it was discovered she did, and then only because she insisted on surgery. Her friends urged her to sue. Instead, she resolved to take action to help other people avoid what she'd gone through.
The fundamental problem, Leotin says, is that doctors don't always understand what it's like to be a patient with a serious illness. With a grant from the Genentech Innovation Fund, she interviewed dozens of patients from marginalized communities and developed a workshop for clinicians at Emory University, intended to help them see health care through those patients' eyes.
'If you're making assumptions about what patients experience, you can do things that are harmful without realizing it. This is the root of mistrust,' Leotin says. And repeated violations of trust cause both physical and mental harm, as well as increased costs from extra testing and delayed diagnosis.
Another project that draws from patients' experiences is underway in Boston. With a grant from the National Institutes of Health, the nonprofit Everyday Boston has teamed up with Boston Medical Center and several community groups in a project to address medical distrust among people of color.
Called
'It's been a humbling and a horrifying experience to hear these stories,' Solomon says. 'When things go wrong, you can almost guarantee that there was a lack of humanity.' The foundation of a solution, Solomon says, is the 'deceptively simple and incredibly powerful' notion of treating people as humans and listening to them.
In a pilot that will be expanded in the fall, students from the state's four medical schools got together with community members to hear their stories. One session was held in Springfield with nine students from the UMass Chan Medical School and nine community members. Ellie Parker, a medical student who helped organize the session, says a classmate told her afterward that it helped him learn how to ask better questions.
'We do so many exercises as medical students in taking a medical history,' Parker says. 'But of course, so much of your interaction with people is just people skills.'
Hearing people's stories lies at the heart of good medicine, says Dr. Jay M. Baruch, a professor of emergency medicine at Brown University. Years ago, as a medical student, Baruch took a year off to study writing and work on a novel. When he returned to medicine, he found that his approach had changed because he was better attuned to patients' narratives.
'Medicine and the patient encounter is essentially a creative act, and we can't care for patients without caring for their stories,' Baruch says. 'Trust begins at the level of entering this story together and lowering our guard, each of us being vulnerable.'
This can happen even in the rushed high-pressure conditions of the emergency room where Baruch works — provided doctors are curious and pay close attention. Early in his career, Baruch recalls, a woman came to the ER with a raft of worrisome complaints. But she seemed strangely content amid the hubbub. Doctors kept her overnight to run tests, and when everything came back normal, Baruch apologetically told her they couldn't detect the problem and asked if he could call someone to pick her up.
'Whatever you do,' the woman replied, 'don't call my husband.'
Baruch realized she'd come to the hospital to escape domestic violence. 'It was like she opened up this door for me that I should have been curious about 12 hours before,' he says.
Baruch says clinicians can form a kind of 'rapid trust' in the ER. Even though trust often needs to be nurtured over many conversations, sometimes it can indeed happen fast.
Leotin, the woman who underwent painful breast biopsies, says a new oncologist 'gained my trust in less than one minute' because he greeted her first with an apology for all she'd been through. That showed he had read her medical records, acknowledged what happened to her, and empathized.
Harding now has Gergen Barnett as a doctor.
Jessica Rinaldi/Globe Staff
And Harding, the woman who fired her doctors, needed only an hour on Zoom to trust the new doctor she found — Gergen Barnett. 'She listened to me,' Harding recalls about that first meeting. 'She asked me questions about me, Cheryl, the person. . . . She trusted me and what I was saying about what I felt about my care.'
Gergen Barnett discovered that Harding had severe iron-deficiency anemia, a condition her previous doctors had somehow missed. A series of iron infusions renewed her energy. Although Harding has multiple health issues — and will turn 79 on May 18 — she says her life has improved despite some limitations. She's been living in her home of 50 years, even though it's still sometimes difficult to climb the stairs. She has the energy to work with Everyday Boston, and travel the world.
'I just came back from Japan last year,' Harding says. She brought her youngest granddaughter, Aria J. Harding. 'We spent 10 days there. It was amazing.'
Felice J. Freyer is a health care journalist and frequent contributor to the
Globe Magazine.
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