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In this episode, we explore the decline in trust within the U.S. health care system and discuss actionable strategies to rebuild it. Matthew Sherrer, associate professor and director of care team collaboration at the University of Alabama at Birmingham, and health care consultant Martin Nowak share insights on how relationship marketing, narrative medicine, and patient-centered care can improve health care experiences and restore confidence in the system. Learn how innovative approaches, such as leveraging technology and shifting to value-based care, can foster trust and strengthen connections between patients and providers.
Matthew Sherrer is an associate professor and director of care team collaboration at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Department of Anesthesiology and Perioperative Medicine. He can be reached on X @MattSherrerMD and LinkedIn. He is also the co-host of the Fresh Flow podcast and has publications on PubMed.
Martin Nowak is a health care consultant.
They discuss the KevinMD article, “Trust in American health care: What’s driving the decline?”
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Matthew Sherrer and Martin Nowak. Matthew’s an anesthesiologist. Martin is a health care consultant. The KevinMD article they wrote is “Trust in American Health Care: What’s Driving the Decline?” Martin and Matthew, welcome back to the show.
Martin Nowak: Thank you.
Matthew Sherrer: Thanks, Kevin. Good to see you.
Kevin Pho: All right, Martin, let’s start with you. Tell us about this article for those who didn’t get a chance to read it.
Martin Nowak: Matt and I discuss frequently about comments we hear from patients or from my clients, and much of that recently in the last year has been a dissatisfaction with health care. In trying to tease that out, there is some literature about this, and we cited some in the article. But the real issue here, we think, is—Matt’s coined the phrase “narrative medicine,” which we think is very important—and a great issue behind the lack of trust in both hospitals, physicians, other caregivers, and certainly insurance, is that the communication is so poor. One of the things I did to help us with our article on KevinMD was I asked a bunch of people at the coffee shop—just wherever I was—”Do you trust your doctor? Do you trust your hospital?” And regrettably, not a single person said, “Oh, wonderful, 100 percent, it’s great.” All the answers were hedging. So Matt and I began researching the literature, and much of the literature looks at single slices of the pie: is it the cost, is it access—whatever it might be. But when you talk to the families and the patients, it’s really some combination. I think we came up with a conclusion that we’re in a perfect storm of many things colliding at the present time. Part of it began with COVID, the pandemic, and part of that had to do with mixed messages out of our leadership in Washington and so forth. But part of it also is declining reimbursement for physicians, and they don’t have as much time. That’s really a bad thing because the whole key is, of course, history and physical—and the history part is so important, and the connection. Just this morning, Gallup published an article—their research view of the youth view of the U.S. health care quality declines to a 24-year low. The people in their survey cited cost and access as the first two things. I’ll just close this part and turn it over to Matt by one other thing: I’ve been visiting a family relative in a local hospital that I trust, that I like, I trust the doctors. But in the waiting room, I asked families over a several-day period, “Well, do you trust this hospital?” And I got answers like, “Well, it’s the one in our neighborhood.” It wasn’t, “Oh yes, it’s a wonderful thing.” Then I got, “Yes, you know, it’s very expensive to be here.” And then what really put the cement on some of the things Matt and I wrote about is that the patients really didn’t know who the doctor was. That didn’t mean the doctor didn’t come in—they’re busy, and there were like five partners in the group, and each day a different partner made rounds. They had to be concise in their work. No issues with that—I had the same thing with the family member I was visiting—but they didn’t know who the doctor was. They didn’t know who the nurse practitioner belonged to. So it was just this whole communication of how one introduces oneself. Matt, your comments.
Kevin Pho: Yeah. So let me ask you, Matt, do you feel that lack of trust, speaking through the lens from the physician standpoint?
Matthew Sherrer: Absolutely, absolutely. Yeah, unfortunately, I do. I hate to give Martin credit for anything on these types of things, but he’s right on this one. Our communication—we’re good friends, and it’s usually, “Hey, Matt, you doctors need to do better at this.” And of course, I always turn that back around: “Hey, Martin, you admins and consultants need to do a better job at this.” But unfortunately, I do feel what he’s talking about. Patients are angry a lot of times—we make them wait for long periods of time, we’re hard to access, care gets denied. There are so many factors that, more and more commonly, when I visit people in the preoperative area, I walk in and it’s pretty apparent right off the bat they’re angry about something. So, yeah, it’s something that’s becoming more prevalent. Martin did a great job of laying out many of the factors, and we certainly don’t have a magic bullet to fix all this—it’s a complex, complex problem. But definitely seeing it on the clinical side.
Kevin Pho: Yeah, it’s really stark how much that anger in patients really manifests recently. Of course, we have the tragic murder of the CEO of UnitedHealth. And if you look it up, the comment section of one of those articles—zero sympathy for that CEO’s family. All of it about the anger toward UnitedHealth and the health care system.
Matthew Sherrer: Yeah, I’ve gotten text messages on that today. Same thing—my friends outside of health care—there’s a lot of vitriol out there. Certainly thoughts and prayers with the Thompson family and with the UnitedHealthcare family as well. Terribly tragic event that just underscores, as you said, Kevin, the vitriol that’s out there.
Martin Nowak: I see the vitriol. Yesterday, I actually looked at LinkedIn and Reddit, both, just to see what the comments were. They are very much alike. It’s only the method and the manner in which the vitriol is expressed on those two social media places. I was quite astounded just how angry those responses are.
Kevin Pho: Yeah. So Martin, when you talk to those patients at the coffee shop, just give us a sample, qualitatively, of some of the comments that they said when you asked them whether they trusted their doctor or hospital.
Martin Nowak: Sure. Obviously, they would say it costs so much, my insurance costs so much—it’s the whole cost thing. One of the areas, though, that I took from them is that they believe the doctor is the captain of the ship. But more so, they believe the doctor should be the captain of the ship. I believe that Matt will confirm that; I have no issues with that. They find that their doctors are not able to be the captain of the ship—insurance denials, days in the hospital, the case manager. And nothing wrong with case managers, but they come in within hours of admission and begin talking to the patient about getting out, and the patient and the family are concerned about being there in the hospital. So it’s rush, rush, rush. And the next day, a different doctor comes in, and the case manager comes back in, and the doctor may come in and say something was denied. And now one thing we didn’t mention is we are reading more and more about fraud—just outright fraud, upcoding, charging for things not done. This then adds to the whole thing. But I find it a tragedy that the doctors are no longer the captains of the ship.
Kevin Pho: Matthew, how does this vitriol and dissatisfaction in our health care system affect the patient care that you give, knowing that sometimes the reason for that vitriol is out of the physician’s control—like the health insurer denials, the pharmacy benefit plan? Sometimes you’re not in control of the cause of that patient anger, so how does that affect you?
Matthew Sherrer: Yeah, we’re not in control many times. One thing I try to come back to—it’s easy to get angry yourself in that situation. I try to tell myself, “Hey, you are in control of your response, right? You’re not in control of what’s given to you, but you do get to control how you respond to that.” One of the things Martin said that I think is true is this “rush, rush, rush.” I’ve tried to really make a point of late to say, “You know what? Being a patient is hard. I’ve been on the other side—I’ve had a sick family member, I had a son who was in the ICU for a long time.” Being on the patient side is very, very hard. Anytime I see residents or colleagues frustrated with their day, it’s easy to point out, “Hey, no matter how bad your day is, it’s not as bad as your patient’s right now.” Being a patient is incredibly, incredibly hard. So trying to have that mindset of “they’re going through something; I can at least come to them with empathy. I can certainly come to them and treat them in a way that’s respectful.” And so what I’ve started to do recently—it’s kind of become my go-to after addressing their issues—is to simply say, “Hey, where are you from?” You know, I’m an Alabama guy. I was born and raised in Birmingham, spent most of my life here, I know most of the surrounding areas. Just start a conversation. It doesn’t have to be that leading question, but that’s the one that I usually go with. Then that leads to, “Oh yeah, certainly, I have relatives there,” or, “I used to work for so-and-so,” and it’s just generating conversation. I think relating to people on that human level has really been beneficial for me in my practice.
Kevin Pho: Martin, how can health care clinicians—how can we regain that trust?
Martin Nowak: Matt has alluded to this. It’s how one addresses the patient, I think, that’s one of the key things. Some of these patients also told me they go to the office, and the nurse practitioner sees them first, and they wanted to see the doctor. If, for example, the physician could just step in for a moment—just for a moment—and say, “This is my nurse practitioner. They’re going to take care of you for now, I’m looking at your records, and I’ll see you on the next visit,” that works. When the doctor comes into the patient’s room in the hospital, they say, “I admitted you. My partner will be in tomorrow, my nurse practitioner may be in, but we’re all watching your record, and we all know about you.” Just those kinds of things really put the patient at ease and feel like the doctor is in control, and that they are in good hands. The physicians have difficulty with the hospital environment, meaning if the whiteboard in front of the patient doesn’t have the nurse’s name on it, the time of day, the diagnosis—some of those things that are helpful for the patient to see—or if the clock is broken on the wall. Those are all important things to the patient that make them feel like… so it’s both. But I think the key for the physician is a bit more communication that really does not take up a great deal of time, and if the patient feels confidence in what the admitting doc tells them, then the admitting doc doesn’t have to be there long periods of time.
Kevin Pho: Matthew, you talk about the importance of narrative medicine in terms of regaining that trust. Talk more about that.
Matthew Sherrer: Yeah, so narrative medicine is a field. My good friend Tom Vedder has written extensively on it—just the idea of establishing rapport in a more humanities-based way to approach patients. There’s plenty of literature out there, but unfortunately not something that has really gained a ton of traction. It’s not like we have a program here at my institution; they are few and far between. But when I read about it, I really think about this idea of focusing on the patient experience, patient engagement, right? Those are things—there have been articles written—that are outside of the physician’s control. I’ve actually pushed back before and said, “Well, time out. Hang on. Martin has just said patients want us to be in control. We are leaders in the health care system, right? So while it may not be our traditional role, if we make it our role, people will listen. People do listen to us in the health care system.” My point is: let’s make patient engagement a priority. Let’s make patient satisfaction a priority. Let’s make patient experience a priority. That’s long been a concept in business—voice of the customer, relationship marketing, etc. Building harmonious experiences for patients, establishing two-way communication. Those types of concepts have been around in business for a while. Let’s take those, let’s make it our responsibility as physician leaders in our institution, and let’s push that. While it may not be our direct responsibility, we can make it our responsibility.
Kevin Pho: Fee for service versus value-based care—sometimes fee for service increases the quantity and increases the financial incentives for physicians to see more patients, and subsequently less time is spent with each patient. How can changes in the physician payment system—do you think that can rebuild some of the trust?
Martin Nowak: Yes, I think that the people I talk to have no issues with physicians being upper-income earners. That’s not the point, but it goes back to narrative medicine. So long as they feel comfortable with the doctor, nobody minds a neurosurgeon making the highest… nobody minds any physician’s income. I’ve just never heard that. But if the physician does not have the time or the ability to talk to them, that becomes the issue. One thing we haven’t talked about here, either, is one of the impinging issues is a decline in public health. As a society, we are not seeing the public’s health getting better. Part of that’s access, part of it is not all the states expanding Medicaid. We just have the whole system is kind of messed up. So it’s a public health issue, it’s a singular health issue, it’s a community health issue. What I am hoping to see in my lifetime, actually, is this return of care more in the hands of physicians, decrease in fraud, decrease in absence—meaning absence of the time spent. And yet the declining payment to physicians is a tragedy. It’s interesting that the anesthesiologists were put back into Anthem just yesterday. If you saw that, that’s a remarkable turnaround, and maybe it’s a harbinger of looking at these things in a much better light, hopefully.
Kevin Pho: Yeah, so I think that story that you were referring to with Anthem—I think that they had dictated how much time is suitable for surgery. With the social media pushback from physicians and anesthesiologists, they rescinded that policy.
Matthew Sherrer: Also great work by our parent society, the American Society of Anesthesiologists, pushed hard against that. That’s why advocacy is so important. I will commend my parent society, of which I am a member, for their hard work there as well.
Martin Nowak: Social media responded, too. They said, “What do you mean they don’t want to pay my doctor for the time he spends with me? Is he going to walk out of the room?” So it was—the society did great, but the public catches on. They get this stuff. You just have to let them know what’s going on—they get it. Yeah, and they were in favor of the anesthesiologists.
Kevin Pho: We’re talking to Matthew Sherrer and Martin Nowak. Matthew is an anesthesiologist; Martin is a health care consultant. The KevinMD article is “Trust in American Health Care: What’s Driving the Decline?” Now I’m going to ask each of you to share some take-home messages with the KevinMD audience. Matthew, why don’t you go first?
Matthew Sherrer: Yeah, I alluded to it earlier. It’s just this spending time with your patients—establishing a narrative, right, just starting a conversation. They want to know that I can take care of them, they want to know that I have the expertise and skill to handle whatever may come while they’re in the operating room. But I think, as we’ve alluded to throughout this episode, there’s also just a certain level of comfort in knowing that I care, right? I care about them, I care about them as a person, I want to know where they’re from, I want to know who’s in the room with them. I know that they’re going through a lot. I know they’re going through a really, really hard time, and I have the privilege of being able to walk through that with them. So if I could encourage my physician colleagues out there—all of our clinician colleagues out there—take some time, get to know your patients. They’re going through really hard stuff, and we get to be there with them.
Kevin Pho: And Martin, we’ll end with you. Your take-home messages?
Martin Nowak: Sure. I think that the confidence of the physician to the patient and family is returned in trust. The greater the confidence, the greater the trust. The second piece is I think if physicians will take just a bit more time—make sure the patient understands their time, meaning “I’ll be back tomorrow,” make sure they introduce the people that represent them—then the patient has great trust in the physician and those who represent them. Those two things would make a world of difference in the trust issue.
Kevin Pho: Martin, Matthew, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.
Martin Nowak: Thank you. Good to see you.
Matthew Sherrer: Thank you so much.
