How the Pandemic Weakened American Trust in Doctors (Part I)
Trust in doctors and hospitals fell sharply over the course of the Covid-19 pandemic, according to a major study from the Journal of the American Medical Association (JAMA)—from 71.5% in April 2020 to 40.1% in January 2024.
Granted, the survey refers to “doctors and hospitals” as a single category, which undermines the usefulness of its findings. Other recent studies suggest that trust in individual physicians remains relatively high, while confidence in large medical institutions has tanked. (The American Medical Association, which publishes JAMA, may have wanted to lump the categories together to obscure the fact that hospitals are so unpopular, for reasons we’ll get into below.)
Nevertheless, the JAMA study—which was released in July and includes responses from over 443,000 adults—reveals that something changed during the pandemic, though it doesn’t meaningfully examine why.
The Covid-19 pandemic served as a flashpoint in America’s pervasive cultural battles—traversing matters of religious liberty, education, personal autonomy, and bureaucratic technocracy. Parents stuck at home were appalled by the content of their kids’ Zoom classes; others were furious that schools remained closed for so long. In November 2020, California governor Gavin Newsom enjoyed a night out at a Michelin-starred restaurant with a large party, just as his administration was warning against gathering with family for Thanksgiving. In 2021, New York City firemen protested Mayor Bill de Blasio’s vaccine mandate, which required public employees to get vaccinated or risk losing their jobs. There were lawsuits against the enforced closures of churches and synagogues while other public accommodations remained open—and while some politicians positively cheered gatherings for the Black Lives Matter movement.
It is no wonder that Americans today are less trusting. A recent Gallup poll shows that we are more suspicious of police officers, psychiatrists, engineers, bankers, lawyers, nurses, and even clergy members, among other professionals, than we were in 2019. There’s a sense that professional standards of ethics are falling away as political and financial influences become more entrenched. This is bad across the board, and especially so when it comes to physicians.
Engineers, bankers, and even lawyers can do good work regardless of whether their customers trust them deeply. But trust is an integral component of quality medical care. Doctors make life-and-death decisions at supremely vulnerable moments in people’s lives. Patients frequently reveal information to doctors that they would not reveal to anyone else; doctors give instructions that patients ignore at their peril. The erosion of a sense of medical professionalism, in undermining general physician-patient trust, can result in substantive damage to the actual practice of medicine.
A suspicion of physicians is baked into the profession’s self-image. Since antiquity, doctors have been trained to be skeptical of their own motives. Oaths of ethics attributed to Hippocrates and Maimonides, along with more modern iterations such as the Declaration of Geneva, all emphasize the humanity and vulnerability of patients, warning doctors not to harm those in their care. Any number of institutions have been put in place to maintain the profession’s integrity, but central to all this is the proper arrangement of the physician-patient relationship, which is too often casually undermined in medical policymaking. Part of the recent “deprofessionalization” of medicine has entailed removing independent decision-making authority from doctors. This was never more evident than during the pandemic.
As I attempted to explain in the New Atlantis in 2021, even before coronavirus vaccines became a political pressure point, frontline doctors were being harangued or blacklisted for engaging in independent medical decision making regarding Covid-19. Putting aside the merits of any given intervention—from masks to social distancing to vaccine mandates—doctors were swept up in a political panic, through which a range of controversial health decisions was imposed on much of the country. Those who vocally questioned establishment dictates were punished; Dr. Aaron Kheriaty was famously fired from UC Irvine’s medical school for refusing to get vaccinated. Whatever doctors might be, it seemed, they were not to be creative and independent agents arriving at medical decisions through their own careful reasoning.
Related to this, as I argued in the Wall Street Journal in 2021, is a combination of economic and political pressures that have routed private medical practices across the country. Most U.S. doctors are now employees, pressed to adopt more subordinate habits of mind. The shift from the small doctor’s office to big-box medicine has not led to discernible improvements in care, but it has eroded the sense that doctors are immediately accountable to patients—rather than to hospital CEOs, research institutions, the government, or large pharma companies.
Even electronic health records, or EHRs, as I discussed last week, prompt doctors away from attending to patients and toward screens. In a way, the click-through approach to medicine infantilizes doctors; rather than being challenged to offer meaningful accounts of their patients’ needs, they are presented with multiple-choice questions prepared by insurers, which do nothing to enhance medical expertise or care. This can also undermine medical professionalism.
Returning to the Gallup poll, 65% of Americans had high or very high confidence in the honesty and ethical standards of medical doctors in 2019; that fell to 56% in 2023. There is a clear partisan divide; 67% of Democratic-leaning respondents reported high levels of trust in physicians, compared to only 48% of respondents who lean Republican. Still, all these numbers are higher than the 40.1% reported by JAMA. That tells us something too.
As noted earlier, in its massive survey, JAMA conflated “doctors and hospitals,” furthering the idea that clinicians and “medical systems” are essentially the same thing. But this approach overlooks, and compromises, the doctor-patient relationship, particularly the independent authority that properly belongs to responsible doctors.