Mistrust and health discrimination Research has shown that mistrust of medical professionals and medical systems results in worse outcomes for patients.
Huzar 2021
If your car breaks down you seek a mechanic; if your tooth hurts you seek a dentist; if you have a health concern you seek a doctor; and if your pet is ill, you seek a vet. It seems logical that when you are not a professional in a given area, you would seek those who are – but medical mistrust has caused human and animal healthcare professionals to encounter people who believe the experts are actively acting against them. Of course, healthy skepticism is beneficial, but when medical mistrust extends so vastly as to encompass entire organisations and cause poorer patient outcomes, these ideologies need to be tackled and the seeds of medical mistrust must be investigated.
As a veterinary professional, my colleagues and I have experienced accusations that we sell complete dry kibble that kills animals, that the Lepto4 vaccine is dangerous and deadly, that vets favour certain treatments over natural means because they deliberately want to make animals sicker, and more. These claims are often disheartening and upsetting, as well as wholly unsubstantiated by robust evidence. When such claims are rebutted on veterinary education platforms using evidence, the onslaught of conspiracy theories just spirals further.
Whether through fear, lack of education, social factors, inability to critically analyse misinformation online or mistrust of motives, we have seen a worrying group of people who passionately and convincingly spread misleading information about the very people who are educated and trained to protect. A sad corollary to this ideology is the idea that doctors prescribe, sell or suggest treatments that are meant to harm, and as such the fallacy of ‘natural is best’ gains momentum.
To add fuel to the fire, the evangelical proponents of ‘natural’ practices (be that herbal treatments, homeopathy, reiki healing, or something else) often form social media groups that become toxic echo chambers and a ‘blizzard of misinformation’, reinforcing their mantra: medicine is bad and natural is good. The accessibility of these social media groups exacerbates the spread of misinformation. Proponents of these ideologies are highly convincing, resolute in their beliefs, and they tend toward categorical thinking and conspiratorial worldviews, bouncing off each other and sinking deeper into their belief system.
How do we dismantle medical mistrust?
In some studies, high levels of medical mistrust are associated with low quality of life, so, of course, health professionals desperately want to improve perceptions and compliance of evidence-based treatment in these groups – but how do we achieve this?
As scientists, we may think that by sensibly presenting evidence or scientific education, this fear will be eradicated. But despite the accuracy and validity of these methods, they can be ineffective against conspiracy theorists due to the inclination and disposition of proponents to believe in conspiracies over evidence and facts. Lewandowsky et al. stated:
Conspiracist ideation is associated with the rejection of all scientific propositions tested… people who endorse one conspiracy are known to be likely to also endorse multiple others… finally, in a reversal of conventional scientific reasoning, evidence against conspiracy theories is often construed as evidence for them, because the evidence is interpreted as arising from the conspiracy in question.
While some conspiracy theories are harmless, even humorous, some have profoundly negative lasting effects. You need only to look at the re-emergence of measles in the UK and USA; countries that had previously, due to vaccination, almost managed to eliminate the disease. This re-emergence was fundamentally caused by a now disproven paper that linked autism to the vaccine. The General Medical Council found the paper’s author, former doctor Andrew Wakefield, guilty of serious professional misconduct – but despite it being withdrawn and disproven by numerous studies, there are still people who continue to cite Wakefield’s research as evidence of the harms of immunisation.
The link between medical skepticism and the natural fallacy has been the subject of recent social-psychological research, which found strong correlations between vaccine skepticism and adherence to complementary and alternative medicine and conspiracy ideation. The results of a 2019 study by Cuevas et al. suggest that mistrust toward healthcare may unfavorably affect patient-clinician interactions and patients’ health-related outcomes. Medical mistrust shouldn’t thrive in a culture that trusts and values the scientific consensus. In order to tackle it, we cannot just present facts, we need to implement a more systemic long-term strategy to address the root causes of medical mistrust.
Some of these issues can be mitigated by physician-focused changes, for example the effects of mistrust can be countered by using patient-centered communication skills. These include soliciting the patient’s concerns and priorities, and being responsive to the healthcare needs and belief system the patient identifies with. The requirement for a long-term strategy is also supported by Benecke and DeYoung (2019), who explain that medical professionals must take a different approach to education, including outreach to vulnerable communities and individuals. The researchers argue these long-term programs should be carried out through collaborative efforts including research by sociologists, psychologists, and public health researchers, to integrate strategies to tackle the issues. They also noted that social media platforms have to play an active role in monitoring and banning false information.
Going forward
Medical mistrust in the human and veterinary fields undoubtedly causes poor patient outcomes, delay in necessary treatment, and further stress and time pressure burdens on overworked and understaffed professionals. Long term plans are needed to tackle the root cause of the issues, and continued education and support is needed for those who have not yet been subjected to misinformation, to allow them to be more critical and skeptical about medical information sources.
At the end of the day, healthcare professionals just want the best for their patients. Who do we trust, if we don’t trust the experts?
Further Reading:
- Browne, Matthew (2018) “Epistemic divides and ontological confusions: The psychology of vaccine scepticism, Human Vaccines & Immunotherapeutics”, 14:10, 2540–2542, DOI: 10.1080/21645515.2018.1480244
- Mitra,Tanushree Counts, S. & Pennebaker, W, J. (2016) “Understanding Anti-Vaccination Attitudes in Social Media” http://people.cs.vt.edu/tmitra/public/papers/Anti-Vax-attitudes-twitter.pdf
- Insights from Psychology: Medical Mistrust and Patients’ Decision Making – KJT Group
- Cuevas, A. G., O’Brien, K., & Saha, S. (2019). Can patient-centered communication reduce the effects of medical mistrust on patients’ decision making? Health Psychology, 38, 4, 325-333. doi: 10.1037/hea0000721
- Huzar, T. (2021) Medical mistrust linked to race/ethnicity and discrimination (medicalnewstoday.com)
- Cuevas AG, O’Brien K, Saha S. Can patient-centered communication reduce the effects of medical mistrust on patients’ decision making? Health Psychol. 2019 Apr;38(4):325-333. doi: 10.1037/hea0000721. PMID: 30896219. Can patient-centered communication reduce the effects of medical mistrust on patients’ decision making? – PubMed (nih.gov)
- Kinlock BL, Parker LJ, Bowie JV, Howard DL, LaVeist TA, Thorpe RJ Jr. High Levels of Medical Mistrust Are Associated With Low Quality of Life Among Black and White Men With Prostate Cancer. Cancer Control. 2017 Jan;24(1):72-77. doi: 10.1177/107327481702400112. PMID: 28178717.
- Incidence of Measles in the United States, 2001-2015 | Global Health | JAMA | JAMA Network
- “I Know Things They Don’t Know!”: The Role of Need for Uniqueness in Belief in Conspiracy Theories: Social Psychology: Vol 48, No 3 (hogrefe.com)
- The Role of Conspiracist Ideation and Worldviews in Predicting Rejection of Science (plos.org)
- Lewandowsky S, Gignac GE, Oberauer K (2015) Correction: The Role of Conspiracist Ideation and Worldviews in Predicting Rejection of Science. PLOS ONE 10(8): e0134773. https://doi.org/10.1371/journal.pone.0134773
- Michael Billig (socialpsychology.org)
- Sharp rise in measles in England amid fears over ‘anti-vaxxers’ | MMR | The Guardian
- Benecke, O., & DeYoung, S. E. (2019). Anti-Vaccine Decision-Making and Measles Resurgence in the United States. Global pediatric health, 6, 2333794X19862949. https://doi.org/10.1177/2333794X19862949
- Doctor who linked MMR jab to autism is struck off | The Independent | The Independent
