How Providers Can Address Medical Mistrust in the U.S.

The COVID-19 pandemic brought to light once again a longstanding history of mistrust for the medical community among people in the U.S. Many were hesitant, for example, to adopt the recommendations of public health officials, with mask and vaccine recommendations being among the most contested.

Previously, we looked at the origins of medical mistrust, including events that shaped the attitudes and beliefs of a wide range of communities and created problems that persist to this day. In this post, we’ll examine ways the healthcare community can begin to address and rebuild trust in individual professions and in medicine as a whole.

Healthcare education

Change begins with educating the next generation of healthcare providers, but many groups of Americans are still underrepresented in healthcare programs. 

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As of 2022, only about 6% of doctors identify as Black or African American, and only about 7% identify as Hispanic, despite these two groups collectively making up over one-third of the U.S. population.

There is evidence that patients benefit in numerous ways when they belong to the same race or ethnicity as their healthcare provider. These benefits, which are associated with improved outcomes, include:

• Better medication adherence

• More accurate perception of lung cancer risk among smokers

• Improvements in patient-provider relationships

In order to see these and the other benefits associated with providers and patients sharing similar backgrounds, healthcare programs have to be more representative of the overall population.

Incorporating diversity into the curriculum

The unique perspectives of healthcare providers from diverse communities are invaluable not only to rebuilding trust in the healthcare community but also to innovating how care is delivered.  

The Mind the Gap initiative, created by Malone Makwende, is a great example of this. After beginning medical school, Makwende quickly became aware of gaps in his curriculum, which didn’t adequately address treating people of color. He was being shown images of skin conditions on white patients, but was left unsure of how to accurately identify that same condition on darker skin. Mind the Gap aims to educate healthcare providers by creating a database of skin conditions as they appear on darker skin.

Healthcare practice

All people, including healthcare providers, carry some form of implicit bias. Studies have shown that providers can have biases against patients who have a high body weight, as well as gender-based and race-based biases against both patients and coworkers.

Left unchecked, biases can negatively influence how healthcare professionals behave toward others. For patients, these negative interactions can cause or exacerbate medical mistrust. Healthcare professionals can help increase the trust patients have in the healthcare system by recognizing and addressing their own negative biases.

Organizations, such as the Association of Women Surgeons, have recommended several steps for reducing negative biases in healthcare settings. These are general steps that all healthcare organizations and professionals can take to reduce negative biases:

• Recognize existing negative biases. Implicit biases are biases that we don’t consciously recognize we have. Workplaces offer opportunities for healthcare providers to both identify and begin to eliminate these biases. Surveys, such as the Implicit Association Test, can measure implicit bias and changes in biases following interventions.

• Recognize how biases manifest in interactions with patients and colleagues. It’s important to understand how biases can influence medical decision-making and interactions with others. When healthcare professionals recognize situations in which negative biases might emerge, they can take steps to counteract their thinking and behavior.

• Learn about diverse populations. Learning about the unique characteristics of and differences among diverse populations can help counter stereotypes. And this can help healthcare professionals become better engaged with the people that they care for.

• Become active bystanders for patients. Healthcare professionals may witness their colleagues demonstrating negative biases about patients or coworkers. Actively addressing bias when it impacts patient care or interactions with colleagues can help victims of negative bias feel safe.

• Participate in creating healthy and safe workplaces that support diversity and inclusion. Recognizing and reducing implicit biases fosters healthy workplace environments, which in turn facilitate positive coworker relationships and good patient care. As part of this, workplaces should consider implementing strategies to encourage diversity and inclusivity in hiring and promotion.

Healthcare professionals who actively seek to reduce their own negative biases can help build trust in the healthcare system. They can also pave the way for innovation that improves care for historically marginalized communities.

Take, for example, a widely publicized medical trial led by the late Dr. Ronald Victor. Dr. Victor, who was white, set out to find ways to address undiagnosed and under-treated hypertension in the Black community. To do so, he partnered with 52 barbershops across Los Angeles. 

In the treatment group, barbers measured their customers’ blood pressure and encouraged them to follow up with a pharmacist, who prescribed blood pressure medication under a collaborative practice agreement. In the control group, barbers measured their customer’s blood pressure but encouraged lifestyle modifications and follow-ups with their primary care provider. 

At 12 months, participants’ systolic blood pressure had fallen almost 29 mmHg in the treatment group and only about 7 mmHg in the control group.

Research

In the field of medical research, there is persistent bias that affects who is represented in clinical trials. 

According to the 2022 FDA’s Drug Trials Snapshots, most patients enrolled in clinical trials were white. This pattern holds true across numerous landmark trials and practice areas, from the PARADIGM-HF study, in which 66% of patients were white, to the EMPA-REG study, in which around 72% of patients were white.

Race is an important factor in clinical trials because it is one of the many patient characteristics that might influence treatment outcomes. Even when studies are one day able to diversify participants based on their genetics, race will remain an essential consideration. That’s because studying how treatments affect people of different races also allows researchers to understand how a person’s environment affects outcomes.

A systematic review in Health Affairs found that Black patients were far more likely to be enrolled in exception from informed consent for emergency research. This kind of research employs a process established by the FDA, in 1996, to bypass informed consent for investigational treatments used in emergency settings. Despite making up just 13.6% of the population, Black people made up 29% of all trial participants in these settings. Meanwhile, 62% of trial participants in these settings were white, although close to 76% of the population is white.

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Written by:

Tracy Asamoah, MD

Tracy Asamoah, MD, is a child and adolescent psychiatrist, writer, and physician coach in private practice in Austin, Texas. She completed medical school at the University of California, San Francisco, and both her general psychiatry residency and child and adolescent fellowship at the David Geffen UCLA School of Medicine.

Written by:

Alex Evans, PharmD, MBA

Alex Evans, PharmD, MBA, has been a pharmacist for 12 years. His first job was floating in a community chain pharmacy.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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