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).
Healthcare is being compromised in a variety of ways. First and foremost physicians practicing “ doorway medicine” second nurses choosing to focus on the symptom rather than do an assessment along with an understanding of the underlying cause. Seems the focus on reducing the lab numbers or blood pressure or reducing the time spent assessing the patient are more important than addressing the underlying cause. Nurses who enter the profession for the money will continue to compromise care and patient outcomes. Physical assessment instead of technology…..identifying underlying problem instead of identifying and treating the symptom.
Medicine, like many aspects of our society has become dehumanized. Science and technology have done wonders for us physically, but we seem to have sold our souls in the process, and it’s so good to hear that nurses still have a human orientation.
I was a psychotherapist for 50 years and we discovered that even psychotic patients could be rescued by using understanding psychotherapy, but the medical profession refused to hear this, and continue to administer toxic drugs without exploring the possibilities of talk therapy; a more humane option.
This photo of nurses is culturally insensitive. It features only white, female nurses. Why did you choose to use this?
Many Nurses can’t be trusted anymore either. Especially Nurse Practitioner Death Monger’s, non-consensually forced onto unknowing patients.
Kimberly K hit the nail on the head. Without accountability, little will change. Spending time listening to patients is another vital factor. As a former Nursing Manager for a large multi specialty medical group, I made the unpopular decision to ban drug reps from seeing physicians during office hours. No breakfasts, lunches or chatting while patients waited.
Yes, sample meds are important but the time reps took away from patient care was more important. They were free to meet before or after patients were seen. Small changes albeit critical to a smoothly run practice focused on spending time with those in need.
And, practicing physicians should never be directly connected (financial partnership) to a pharmaceutical, medical device/equipment company or nursing home. That’s a conflict of interest.
Law changes matter. State medical societies need to bolster— not oppose—nurse practitioner law changes. There is plenty of room in the tent.
I am a fired whistleblower from a large university and medical campus, which is also a long-time CIA hub. I know there are wonderful people in all professions, but I have been exposed to horrors we thought were decades in the past … Although, no one can say for sure if some of the programs in the US, MKULTRA for example, ever really ended … This MUST stop, patients MUST have options for better security and monitoring, and the CIA MUST be out of our schools and medical institutions. See ourconstitution.info Home and under that Medical-Military Industrial, as well as Links pages. Feel free to email me with any questions, other information, etc. I protest in Miami in these regards — see my pics online, join me or protest wherever you are, before it is too late.
My great thanks to all US nurses, whose strikes I’ve supported strongly, and one of whom is a beloved cousin, another two (men btw, though that’s a coincidence) admired friends. But this picture of nurses as empathetic “angels in the house” comes from yet another MD who hasn’t spent time with these overburdened, physically taxed, underappreciated professionals. I’ve had a lot of surgeries, also spent post-surgical time in treatment facilities, also been a few times to the ER in real emergencies of my own and with my elderly father (who at 80 with a burst abdominal aneurysm was made to wait 10 hours at a Cleveland Clinic ER!). I’ve never had the same nurse in any given 3-, or in ER 1-hour period. I’ve never had quick success in calling one when I was in pain–one nurse used to unplug the call button at night! I’ve been left on gurneys without a bedpan until I had to let go and soak the sheets in urine–then left longer. No one remembers my name. This isn’t usually the fault of the nurses (though I had one clearly sadistic night nurse who withheld post-operative pain pills when they were simply Tylenol, leaving me unable to sleep and thus to heal). It’s the fault of grotesquely greedy hospital management, the same people the nurses try to go on strike against, claiming, correctly in my experience, that their case loads leave them not only physically drained and in pain but unable to properly care for their patients.
Does he not now that the makeup of med school classes is now 50% (or more) female? That pediatrics is now becoming mostly female- example daughter’s residency class is 10 women, 3 men. And their supervisor (attending) is also female. Ratio is tipped to women in ob/gyn too. Too bad the poll didn’t break it down by specailty.
Kudos to Dr Warraich for acknowledging the long standing record of trust that nurses bring to individuals across all walks of life. However, as a nurse leader I think he missed the boat on the reasons physicians lag behind. Their problems are not due to electronic documentation, gender, time, etc. It boils down to a much more practical role that nurses consistently fulfill and physicians struggle with – the role of patient advocacy.
If physicians want to improve their trust standing they are right to look to nurses for inspiration – but don’t expect to find excuses rooted in electronic documentation, gender, amount of time spent, etc.; these are simplistic and trans-professional issues that affect all clinical staff – not just doctors. For those who are serious about tackling the physician-patient trust problem you may consider a bolder set of actions directly related to improving patient advocacy – such as holding colleagues accountable for preventable medical errors, critically reviewing and rejecting so-called peer review literature that is biased, dealing with overprescribing and eliminating inappropriate partnerships with medical device and pharmaceutical companies.
The opiate crisis is instructive in terms of the scope of opportunity for physicians; so much focus on the pharmaceutical companies for fomenting the crisis but the average consumer is completely aware that access to these medications always starts with a physician perspcription. So, where is physician accountability? If you want to build trust, you have to start by actually speaking the truth.
Well said, Kimberley K. I agree 100%.
I agree, 100%, Kimberley. Enough excuses! It’s a rare doc these days that LISTENS. RN’s always do. And can everyone just stop calling med assistants ‘nurses’? They are NOT nurses! (nor am I but I respect & trust RN’s & docs? Very, very few.
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