Physicians, once among the most trusted professionals in the United States, now face a credibility crisis. Only one-third of Americans say they have a great deal of trust in physicians, down from around two-thirds in the 1970s. This lack of trust is leading to a burgeoning appetite for medical misinformation, causing many Americans to avoid vaccines and cholesterol-lowering statins.
To quell this rising tide, I believe that my physician colleagues and I should learn from the most trusted professionals in America for 16 straight years: nurses. In a national Gallup poll, 82% of Americans rated nurses’ honesty and ethical standards as “high” or “very high.” These data are an incredible recognition of the most compassionate people in the health system.
A key reason people trust nurses more than doctors is that nurses spend more time with them. Physicians spend less time with their patients than with their computers because of the excessive documentation they are required to do. While physicians might be tied up ordering medications or writing notes into an electronic health record, nurses are in constant touch with patients: cleaning their wounds, giving them food, administering medications, and advocating on their behalf. The time they spend with patients and the empathy and kindness they display is not just by happenstance but is a core aspect of their training.
Nurses’ contact with patients also makes them natural allies and powerful advocates on their behalf. Research suggests that nurses are more vigilant about patient safety, are more empathetic and are more honest, especially at the end of life. In fact, nurses are more accurate than doctors at predicting which patients might pass away in the hospital, while doctors are better at longer-term estimates. Yet this very proximity to patients also makes them particularly vulnerable to moral distress.
Many of the reasons people don’t trust doctors has to do with the health system we all are handcuffed to. Even though the United States spends more per capita on healthcare than any country in the world, the quality of that care and the outcomes it yields are worse than most other high-income countries. People live longer with disabilities from disease and financial toxicity from their treatments.
Leaders in medicine, however, are increasingly taking note of growing distrust in physicians. At a recent meeting I attended organized by the American Board of Internal Medicine Foundation, several strategies were proposed to overcome it. These included increasing medical students’ and physicians’ proficiency with social media, reducing financial conflicts of interests, and partnering with Silicon Valley to promote accurate information on the Internet.
One of the participants noted that despite a diverse presence of physicians, researchers, patient advocates, and journalists, there wasn’t a single nurse in attendance. The consequence of such an omission is underscored by what happens when nurses and doctors collaborate. Physicians and nurses working better as a team not only improves job satisfaction for both but is also associated with better patient outcomes. When nurses and doctors agree about how a patient is doing, they end up being more accurate about patients’ prognoses.
If we are to reshape medical care and how it is perceived, the power dynamics between physicians and nurses need to be evened out.
Some of the differences in public perception of nurses and physicians may be due to gender. Women are both more empathetic and are considered more trustworthy than men. While nurses are overwhelmingly female, women continue to be under-represented among practicing physicians and in leadership positions.
If physicians are to regain the public’s confidence, we must emulate how nurses came to be the most trusted professionals in the United States. Systems should be designed, technologies developed, and payments configured in ways that allow physicians to spend more time with their patients. Until that happens, we need to make whatever time we get count and really connect with patients. Increasing gender and racial diversity among physicians is essential.
From the moment I first stepped into a hospital ward, nurses taught me (and countless other physicians) the essentials of how to be good doctors. When nurses and physicians work together, and learn from each other, everybody wins, especially patients.
Haider Warraich, M.D., is a cardiologist at Duke University Medical Center and author of the forthcoming “State of the Heart: Exploring the History, Science & Future of Cardiac Disease” (St. Martin’s Press, July 2019).