Most Patients Have Confidence in Doctors, but Skeptical About Conflicts

Most Americans have confidence in their physicians — with a few caveats, according to a survey published online on August 2 by the Pew Research Center, a nonprofit, nonpartisan think tank based in Washington, DC.

Almost three quarters (74%) of those surveyed have a positive overall view of physicians, but their confidence does not extend to issues of professional misconduct, conflicts of interest, or transparency in medicine.

The researchers surveyed 4464 randomly selected US adults in January 2019. Questions concerned views regarding scientific researchers and practitioners in three fields: medicine, nutrition, and the environment.

The results of the report indicate that public trust in scientists is on par with trust in the military — 87% of those questioned reported that they had at least a "fair amount" of confidence that scientists act in the public interest.

Trust is higher in practitioners than in researchers: "Physicians stand out along with dietitians as groups [toward which] the public tends to hold more positive and more trusting views," Cary Funk, PhD, director of science and society research at the Pew Research Center, who is one of the authors of the report, told Medscape Medical News.

"On the negative side, we see widespread skepticism around issues of scientific integrity," she added.

Physicians are held in higher regard than medical researchers; 57% of Americans agreeed that "doctors care about the best interests of their patients all or most of the time," compared to just 35% for medical researchers.

Slightly fewer than half of those surveyed (48%) believe their physicians "provide fair and accurate treatment information all or most of the time," whereas only 32% said medical researchers provide accurate information when discussing their findings. Reviews from independent committees and openness to a second opinion were associated with higher levels of confidence in a practitioner's recommendations, said Funk.

Conflicts of Interest a Sticking Point

Despite having largely positive views of their physicians' abilities to care for them, survey respondents were skeptical when it comes to transparency and integrity: only 15% of those surveyed trust their physician to be transparent about potential conflicts of interest with industry groups, and only 12% trust physicians to admit their mistakes and take responsibility for them.

Black and Hispanic Americans were more likely than whites to regard professional misconduct among physicians as a moderately big or very big problem — 71%, 63%, and 43%, respectively.

Slightly more Republicans (77%) than Democrats (73%) had a mostly positive view of medical physicians, but Democrats were significantly more likely than Republicans to trust the objectivity of scientists and the scientific method.

As for the repercussions of misconduct and dishonesty, most respondents did not believe they are sufficient: 80% of respondents said they expect physicians to face serious consequences for their actions just some, a little, or none of the time.

The disconnect between confidence in physicians' abilities to care for their patients and distrust in their integrity might come down to Americans' dwindling trust in institutions, said Robert J. Blendon, ScD, professor of health policy at the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, who was not involved in the Pew Center's report.

"It's very important to realize that even though the title of the report is Trust in Scientists, they didn't ask them about trust," Blendon told Medscape Medical News. The respondents were asked whether they had positive views toward them, "and it's possible to have a positive image about people who are very good at what they do, but not necessarily trust them in public debates," Blendon said.

Still, the Pew Center's poll went much further than other similar studies by distinguishing between confidence in practicing physicians and concerns about transparency and misconduct, said Blendon, who coauthored a 2014 perspective on public trust in physicians that was published in the New England Journal of Medicine.

Blendon and his colleagues similarly found that patients were highly satisfied with the care they received from their physicians, but their public trust in medical institutions was low overall. "People think physicians who care for them are very good, but that doesn't mean they trust their statements in debates over national healthcare," he said.

Distrust in physicians is "absolutely a threat to public health," according to Blendon, because it bears on the likelihood that patients will follow treatments or recommendations regarding prevention. The ongoing measles epidemic is a clear example of what can happen when the public's trust in medical recommendations erodes.

To begin rebuilding that trust, "we really have to think more clearly about handling medical errors and how we disclose financial conflicts," Blendon said.

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