Table of Contents
Health is the core life value as it occupies the highest position in the hierarchy of human needs. It is one of the most significant components of human happiness, and one of the major conditions for the successful social and economic development. Implementation of intellectual, moral, spiritual, physical and reproductive potentials is possible only in a healthy society. The key task of medicine is to protect the psychophysical well-being of citizens. Physicians as representatives of medical institutions and the entire health system provide the primary support to people by encouraging them to lead a healthy lifestyle, providing treatment and educating them on disease prevention. Trust is the foundation of the healthy and productive relationships between patients and physicians. The current research examines the health protection issues in the United States, as well as investigates the trusting relationship between patients and physicians, including means of strengthening them because trust is the basis of health protection.
The Importance of Trust between Patient and Physician
Americans are a nation that cares for its health. However, it does not mean that they do not encounter health problems. In 2013, the scientists summarized the ten most common causes of death among the population. The list included cancer, cardiovascular diseases, unintentional injuries, Alzheimer’s disease, stroke, chronic lower respiratory diseases, influenza and pneumonia, diabetes, nephritis, and suicide. Thus, according to statistics, these ten reasons were responsible for 74% of the 2.6 million deaths (Centers for Disease Control and Prevention, National Center for Health Statistics, 2015). However, the year 2013 showed that a significant part of the American population did not have any problems with health.15.8% of citizens did not seek health care at all, 47% of them were registered to undergo treatment by health representatives, 24.5% of respondents mentioned 4-9 contacts with doctors, and only 12.7% of Americans admitted that they visited health facilities over 10 times (Centers for Disease Control and Prevention, National Center for Health Statistics, 2015). Those visits included certain requests for qualified assistance in overcoming diseases, diagnosis and prevention of injuries; contacts with the physicians in the hospitals and emergency department, as well as home visits by medical experts, etc. Regardless of the frequency of treatment in medical institutions, everyone is faced with a serious dilemma of trust or distrust towards a therapist.
The concept of trust is used in sociological, economic, political, anthropological and other studies. It can be defined as a mental condition in virtue of which the person relies on an opinion that seems authoritative, and refuses to research independently the question that can be investigated on one’s own. Trust, in contrast to hope and confidence, focuses on the future and is directed towards another individual. It also contains more pronounced cognitive and behavioral components. Thus, a patient, who trusts a doctor, actually shares the care for his/her health with a medical specialist.
The Indian scientist Gopichandran (2013) analyzed the western studies, including the US ones, and concluded that patients (e.g. Americans) differently explain their understanding of this concept in terms of medicine. Some of them identified trust towards physicians as a set of expectations towards the medical actions of a specialist. The others explained trust as a sense of confidence or reassurance in the doctor and his/her methods of treatment. Another definition of trust, which is the most suitable for medical institutions, stands for the tacit agreement between two or more parties, which provide a set of conditions or concerted activities for each of the participants, without a fear that a patient or medical personnel will change the terms of the agreement. The fourth definition of trust in the health sector is the optimistic belief of the patient that a doctor will do everything possible to treat him/her in accordance with the highest moral convictions. Thus, trust is a set of expectations suggesting that the healthcare provider will do everything possible for the patient with the personal ethical interest in the successful outcome of treatment or an affirmative result of preventive measures. In any case, trust serves as the fundamental basis for the voluntary informed consent.
However, trust cannot be one-sided as it is closely connected with the health and life of patients. It is obvious to take into account trust of a person in the health care because the course of treatment depends on whether a person is ready to visit a physician at all. At the same time, the US researchers have found that the credibility of a therapist to a patient is no less important for the current research (Thom et al., 2011). Only mutual trust can ensure proper treatment and progressive results.
Trust of a physician in a patient includes the following. Just like a patient who must be confident that he/she is provided all the necessary information, a doctor must be sure that the patient is ready to accept information. An adequate response to the diagnosis and constructive dialogue are a prerequisite for transparency on behalf of the doctor. Moreover, every responsible physician hopes that his/her findings will be correctly interpreted, and designated recommendations will be carried out. It is particularly important in cases where the medical worker uses an individual approach to every patient and develops personalized therapies. Patient’s well-being and life depend on the accuracy of the execution of instructions. Thus, the physician must be sure that these instructions will be taken seriously by the patient.Want an expert to write a paper for you Talk to an operator now
Mutual trust between patient and doctor is the basis for the fruitful cooperation, whose primary goal is to conquer the disease and maintain a healthy lifestyle. Thus, the establishment of trust should be done on the mutual terms and at all levels.
Factors that Contribute to the Confidence-Building or Cause Distrust
In the process of communication, trust could be established and repeatedly subjected to the tests in the physician-patient system. Thus, there are gradually formed the basic structural components of the health professional’s confidence in the patient, which include the following: 1) presentation of the personal qualities and typical behavior of a patient during treatment; 2) assessment of readiness of a patient to adhere to the prescribed treatment course; 3) convergence of ideological orientation; 4) positive emotional attitude of the patient to his/her therapist. At the same time, there exists a set of fundamental structural components of the patient’s trust in the physician, which contains the following aspects: 1) awareness about the professional and personal qualities of a medical professional; 2) conversance of his/her professional competence; 3) convergence of ideological orientation; 4) positive emotional attitude of the doctor to his/her patient; 5) role expectations.
Such structural components are formed under the influence of certain factors that can strengthen the trust between patients and doctors. Mutual reliance between the medical practitioner and the patient can be reached under the conditions of self-disclosure of personalities, no attempts to hide the requested information, a permanent dialogue on the acceptability of treatment methods, providing the patient with the right to choose the procedures and medications from the list of available products, etc. It is important to emphasize the doctor’s self-interest and his/her deep participation in the treatment of the patient because the health issues are very intimate for every person. It is difficult for most people to discuss them. During long-term treatment, a physician becomes the most important person in the patient’s life. Thus, credibility is increased in direct proportion to the personal involvement of a health professional.
An additional trust-building factor can be the guarantee of confidentiality in respect to patient’s personal information (Oracle, 2011). The core task of every doctor is not to harm the patient, either morally, or physically. Thus, professional duty requires referring carefully to any private information on behalf of a physician.
Mutual self-disclosure in a tandem patient-doctor suggests regular conversations with the elements of psychological help from a therapist. They should openly share ideas about the disease occurrence and expectations of the each party. A physician must find a common language with his/her patient and try to explain to him/her every stage of treatment avoiding complicated terms and confusing concepts. Moreover, a therapist should tactfully provide information about the patient’s health. In this case, he/she will be able to assess the adequacy of the patient’s perception and his/her willingness to take joint decisions, while the patient would be able to evaluate the doctor’s honesty and careful attention.
Accordingly to the American studies, among the factors that can undermine the trust between patients and doctors can be determined the following: 1) doctors being paid pharmaceutical companies; 2) lack of mutually addressed questions from a physician or a patient in the event of misunderstanding; 3) too high expectations from the side of a patient and blind confidence in the fact that a physician can answer all the questions (as a result, the patient experiences frustration after learning about the real state of affairs); 4) physician’s expectation that a patient will be able to precisely define his/her requirements or preferences; 5) physician’s unwillingness to use new approaches in the treatment and rejection of the modern medical achievements; 6) expectation of miracles by patients; 7) denial of the right to make a mistake, or the human factor in the treatment process or decision-making (Leng, 2013).
Sometimes the causes of distrust are generated by biased factors that are the result of prejudice. These include the following: gender, age, ethnical identity, sex, and religious affiliation. For example, in the US, a lot of African Americans feel lack of trust in the white physicians and prefer to receive health care information from the informal sources (Musa et al., 2009). However, American experts underline that medical workers should not over-focus on the preferences of patients, who are more inclined to choose a doctor according to the racial or gender characteristics. From the ethical point of view (e.g. utilitarianism), it can be justified because the ultimate goal (the patient’s recovery) is more important than the methods of achieving this goal. Thus, if the patient feels more confidence in the preferred doctor, it can positively affect his/her state of mind and the final result of treatment.
Reasons for Reducing the Level of Trust to the Doctors in the United States and the Ways to Increase the Level of Citizens’ Confidence
The current stage of improving and reforming the US health care system is characterized by the contradictory situation in terms of the American citizens’ trust in medical practitioners. According to the investigation supported by the Robert Wood Johnson Foundation, it is obvious that public confidence in the American physicians has dropped dramatically over the past half a century. For example, in 1966 nearly 73% of Americans indicated their high level of trust in the medical practitioners; however, in 2012, only 34% of citizens expressed their willingness to rely on the medical workers (Blendon, Benson, & Hero, 2014). Despite this situation, most people consider the American Medical level trustworthy. In recent years, 69% of Americans have estimated doctors as a social group with very high or low characteristics thanks to the honesty and ethical standards (Blendon et al., 2014).
Americans consider doctors as individuals and trust them as professionals. Nevertheless, they are not confident in the health system effectiveness (only 23% of people have a relatively high level of respect for it), taking into account the implementation of compulsory insurance, which makes the cost of medical services for some segments of society too high (Purpura et al., 2013). Thus, physicians as hostages of the system become victims of the patients’ suspicious attitude. The majority of citizens have been satisfied with their infrequent visits to the doctors (about 56% of adults); however, the level of trust is directly related to the average income level of citizens (Blendon et al., 2014). The results of the poll have shown that only 47% of adults in the United States from low-income families are satisfied with their medical care, considering the medical services as trustworthy (Blendon et al., 2014). In contrast, the same viewpoint has been supported by 63% of Americans from families with average and above average income levels (Blendon et al., 2014).
The described situation is widely discussed by the American experts, who believe that the general decline in the level of trust in American medicine is caused by the inability of citizens with low incomes to purchase the obligatory insurance. Despite the existence of organizations that monitor the quality of medical services, various structures are supported by the competing political forces that affect the citizens’ excessive spending. Thus, the medical services have become less accessible to the most vulnerable categories of citizens contrary to general expectations.
Social trust in physicians can be increased if the health system leaders consciously develop favorable policies that will improve the health of the nation and bring healthcare to the next level, even if it might be disadvantageous to some physicians. Public polls have shown that Americans consider high costs to be the most significant problem in the US healthcare system, and nearly two-thirds of the population (65%) believe that this money is burdensome for the state (Blendon et al., 2014). Moreover, the creation of medical committees, which could provide help to low-income Americans, would significantly strengthen the credibility of the medical workers among the impecunious citizens. It would be a mutually beneficial action, given that the citizens’ trust can raise the authority of physicians and enable them to influence the political decisions without being extremely dependent on them.
The medical system should be refocused to the provision of preventive health services. Levi, Segal, Gougelet, and Laurent (2015) highlight that tens of millions of Americans currently suffer from preventable diseases, including cancer, cardio illnesses, and diabetes. It indicates that American children are in danger of becoming the first generation in the US history that will live less and suffer more than the representatives of the previous ones.
In 2013, federal, state and local institutions have spent 10% less money for preventive measures than in 2009 ($ 239 per person in 2013 as opposed to $ 241 - in 2009) (Levi et al., 2015). Investments in preventive medicine make it possible to avoid not only health problems but also the excessive financial costs of citizens for further treatment. Such concerns for the health and general well-being of Americans will undoubtedly facilitate a surge of trust not only in the physicians but also in the entire health care system.
The research paper has proven that human health is the most significant value. The health care system is designed to protect the health and well-being of citizens. Thus, mutual trust between patients and physicians forms the foundation for building confidential relationships between the two parties. Only such kind of cooperation can be the key to successful treatment and implementation of preventive measures.
The current level of American public trust in physicians is unacceptably low due to a general lack of credence for the state health care system. It is necessary to reorient the accents in health care in order to strengthen the confidence of citizens in medical practitioners. Medical services should be more accessible to people from low-income families. Additionally, governmental and non-official institutions should actively support preventive medicine because its development will help to maintain the national health and the well-being of every American.