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Thoughts on Medical Trust

Robert Saul, MD asserts that the public needs to trust the medical profession. Suspicion erodes trust, he says, and makes us all engaged in an “us vs. them” instead of a path toward common good to help us all.

September 5, 2023

In many ways, my retirement from active clinical practice at the end of 2020 was well-timed. I was able to avoid almost 2 more years of masked encounters.  I put myself at less risk for catching COVID-19.  I did not have to actively share the frustration of my colleagues with the erosion of trust in the medical profession, especially my specialty of pediatrics.

Yet, after retirement, I served as president of the SC Chapter of the American Academy of Pediatrics.  It was then my role to be a strong advocate and voice for all of our members.  I answered emails, wrote letters, spoke with TV reporters, and garnered support from multiple quarters to support important issues for children and families.  I engaged with state and national advocates to fight the good fight, even working with a national organization to fight destructive policies that were harmful to children.

At the end of my term as president (August 2022), I reflected on the status of my profession and its status in our society.  I was discouraged by the erosion of trust in the medical profession, yet determined to persist as an advocate for children, families and communities.  This destructive process will continue to eat away at the profession of medicine and its ability to positively impact people and communities.

 

I was discouraged by the erosion of trust in the medical profession, yet determined to persist as an advocate for children, families and communities. Click To Tweet

 

While the skeptic might argue that my concern is a selfish one, that I am worried about the profession and its financial preservation.  Being retired, that is not even a thought for me.  I am more worried about the dismissal of such valued resources, folks who have spent significant time and energy to learning facts and interpretive skills.  In addition, their emotional commitment to others over decades makes a difference in the lives of others, their fellow citizens.  They didn’t learn and practice these interactions from internet searches, but rather from intense instruction and repeated practice and commitment to continuous improvement.

So-called “experts” from Google searches are dangerous in my opinion and destroy a system that serves us well. I want to address some of the issues that are currently at play.

 

  • Vaccines

    • Over the course of my career, vaccines have literally become life savers for many childhood diseases. I have never seen a case of polio. Some severe brain infections that led to death during my training are not seen now.  Bacterial ear infections have decreased also.  Chicken pox and measles could lead to significant side effects and those are now largely preventable.  Some cancers are now even greatly diminished by vaccines in the second decade of life. Flu vaccine does not prevent all influenza infections but markedly protects from hospitalization and death.
    • Yet erroneous information has been disseminated that measles vaccine causes autism, that vaccines are harmful and that “natural infection” is safer. The expertise of those who have spent their entire lives developing the vaccines (because of their concern for those adversely affected) and the expertise of those who have spent their careers observing and hoping for these diseases to go away is too easily dismissed by those without the expertise. The lack of trust is very discouraging.

 

  • COVID

    • The impact of the pandemic was devastating to the US and beyond. Over 1 million folks died in the US.  A small percentage of these deaths were in children, but the loss of any family member has an effect on children. It is estimated that over 250,000 children in the US lost a primary or secondary caregiver and over 10.5 million worldwide.  Children also suffered some serious side effects.  I don’t consider hospitalization to be a minor inconvenience.
    • Yet too many people erroneously dismissed the effects on children. Using masks was scoffed at as unnecessary yet the evidence clearly demonstrated the safety and protection.  Too little attention was given to the widening academic gap and increasing mental health/emotional issues that worsened over the course of the pandemic.  These latter two conditions were present before the pandemic, having been ignored for too long and only exacerbated due to the pandemic.  The benefits of COVID vaccines were belittled by too many and as a result the rate of vaccine uptake is dismal in our country.  Too many fear-mongers spread falsehoods about the small risk of acceptable side effects.  By protecting children, we protect adults also—and then we are appropriately protecting families.  The lack of trust is very discouraging.

 

I was discouraged by the erosion of trust in the medical profession, yet determined to persist as an advocate for children, families and communities.

 

  • Public health

    • Folks who know science, infectious disease and the spread of infectious disease led the charge to alert the public and suggest tangible ways to contain the pandemic. They were using science (which at times uses incomplete information and extrapolates based on other principles) and were basing their suggestions for action on previous experience in similar pandemics and a knowledge of how disease spreads.
    • Yet their efforts were far too often greeted with disdain and disregard by other public officials. It was as if these non-scientific officials knew more information and that the public health officials were purposely trying to harm, instead of trying to protect, others.  The lack of trust is very discouraging.

 

  • Education and expertise

    • We require our medical professionals to undergo extensive training (4 years of college, 4 years of medical school, and 3+ years of residency training) before they can independently practice medicine. Along the way they must pass certifying examinations and participate in ongoing education to maintain certification.  In short, they are engaged in life-long learning to do their best to help others.
    • Yet, folks with no expertise can render an opinion that is not based on valid information and then spread that opinion via our “shouting” platforms (social media) and call into question the experts. The lack of trust is discouraging.

 

  • Prevention

    • One of the most significant tenets of medicine is prevention. While doctors have historically been trained in a medical model (diagnose and treat), our goals should be prevention.  If we can prevent (or at least diminish) the effects of physical disease and mental health disorders, we should make every effort possible.  And these efforts often need a social solution that requires medical providers to partner with others.  These solutions include better education efforts, decreasing poverty rates, increasing economic opportunities, acknowledging and addressing racism, improving community resources, seeking joint solutions to gun violence, and so many more.
    • Yet we have often been told to stay in our lane. Pediatricians are on the right highway and all lanes are appropriate for us to assist our fellow “drivers and passengers.”  The lack of trust is discouraging.

 

I am painfully aware that the practice of medicine is not perfect—and that its practitioners are human, capable of mistakes and errors in judgment.

 

The lack of trust is discouraging.

 

Now in my eighth decade of life, I have made some of those errors and I have been on the receiving end of some of those errors.

As a physician, I have acknowledged my errors and addressed them with the families.  As a patient, I have recognized the imperfect nature of medicine, accepting some of those less than perfect outcomes and engaged with my physicians to seek reasonable solutions in a trusting relationship.

Trust is key to all relationships.  Skepticism breeds distrust and erodes reasonable interactions and interpersonal relationships. The brewing distrust for medicine and science that has bubbled up, especially during the pandemic, only serves to diminish health care (acute, chronic, supportive and preventive).

 

 

The public needs to trust the medical profession. Suspicion erodes trust and makes us all engaged in an “us vs. them” instead of a path toward common good to help us all. Dr. Dipesh Navsaria has written on the foundational basis of pediatric care –  a mutual trust with provider and family.2 Both parties need to be honest, work from a trusted framework and exchange information in meaningful ways.

Physicians share a mutual goal to improve the health and well-being of the children and families in their care, and even those not in their direct care if we are seeking preventive measures.  And children grow into adults that we desire to be healthy and supportive parents and good citizens.  Trust is key, and trust is the vital link, and trust is the secret sauce to success.

 

VC: Dana Corriel, MD

(Find Professor Saul’s book, Conscious Parenting, inside our BOOKS section, or directly here.)

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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