Building Trust to Promote a More Equitable Health Care System
Authors: Richard J. Baron, Dhruv Khullar
Journal: Annals of Internal Medicine (2021)

Ideas and OpinionsApril 2021Building Trust to Promote a More Equitable Health Care SystemRichard J. Baron, MD and Dhruv Khullar, MD, MPPRichard J. Baron, MDAmerican Board of Internal Medicine and ABIM Foundation, Philadelphia, Pennsylvania (R.J.B.)Search for more papers by this author and Dhruv Khullar, MD, MPPWeill Cornell Medical College, New York, New York (D.K.).Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-6984 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Physicians must engender patient trust. At a time when science is under attack, patients—particularly those in historically marginalized communities—are increasingly skeptical about the health-related counsel they receive. The coronavirus disease 2019 (COVID-19) pandemic, while sparing few communities, has highlighted stark health disparities that threaten vulnerable populations (1). Many inequities stem from institutional attitudes and structures—both within and outside health care—that systematically disadvantage certain communities. Against this backdrop, nurturing trusting relationships between physicians and patients is an urgent objective.Any discussion of trust in health care must recognize “earned mistrust.” Clinicians may struggle to understand why patients would not trust them. ...References1. Mackey K, Ayers CK, Kondo KK, et al. Racial and ethnic disparities in COVID-19–related infections, hospitalizations, and deaths. A systematic review. Ann Intern Med. 2020. doi:10.7326/M20-6306 LinkGoogle Scholar2. Centers for Disease Control and Prevention. COVID-19 hospitalization and death by race/ethnicity. Updated 30 November 2020. Accessed at www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html on 13 January 2021. Google Scholar3. Jacobs EA, Rolle I, Ferrans CE, et al. Understanding African Americans' views of the trustworthiness of physicians. J Gen Intern Med. 2006;21:642-7. [PMID: 16808750] CrossrefMedlineGoogle Scholar4. Khullar D. Building trust in health care—why, where, and how. JAMA. 2019. [PMID: 31305868] doi:10.1001/jama.2019.4892 CrossrefGoogle Scholar5. ABIM Foundation. 2020 ABIM Foundation Forum: Building Trust & Health Equity. Accessed at https://abimfoundation.org/what-we-do/rebuilding-trust-in-health-care/2020-abim-foundation-forum-building-trust-health-equity on 13 January 2021. Google Scholar6. Roswell R. Workforce Training. ABIM Foundation. 7 October 2020. Accessed at https://abimfoundation.org/video/workforce-training-rob-roswell on 13 January 2021. Google Scholar7. Obermeyer Z. Evidence/Algorithm Bias. ABIM Foundation. 7 October 2020. Accessed at https://abimfoundation.org/video/evidence-algorithm-bias-ziad-obermeyer on 13 January 2021. Google Scholar8. Gaeta J. Health Care for Homeless Individuals. ABIM Foundation. 7 October 2020. Accessed at https://abimfoundation.org/video/health-care-for-homeless-individuals-jessie-gaeta on 13 January 2021. Google Scholar9. Udow-Phillips M. Public Health Implications. ABIM Foundation. 7 October 2020. Accessed at https://abimfoundation.org/video/public-health-implications-marianne-udow-phillips on 13 January 2021. Google Scholar10. Ranney M. Gun Violence: Public Health Approach. ABIM Foundation. 7 October 2020. Accessed at https://abimfoundation.org/video/gun-violence-public-health-approach-megan-ranney on 13 January 2021. Google Scholar Author, Article, and Disclosure InformationAffiliations: American Board of Internal Medicine and ABIM Foundation, Philadelphia, Pennsylvania (R.J.B.)Weill Cornell Medical College, New York, New York (D.K.).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-6984.Corresponding Author: Richard J. Baron, MD, President and CEO, American Board of Internal Medicine and the ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106; e-mail, [email protected]org.Current Author Addresses: Dr. Baron: American Board of Internal Medicine and the ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.Dr. Khullar: Weill Cornell Department of Population Health Sciences, 402 East 67th Street, New York, NY 10065.Author Contributions: Conception and design: R.J. Baron, D. Khullar.Drafting of the article: R.J. Baron, D. Khullar.Critical revision of the article for important intellectual content: D. Khullar.Final approval of the article: R.J. Baron, D. Khullar.Administrative, technical, or logistic support: R.J. Baron.This article was published at Annals.org on 2 February 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEquitable well-being, social trust, and the economy: An integrated health system's perspectives on the long-term implications of COVID-19Artificial intelligence in gastroenterology and hepatology: how to advance clinical practice while ensuring health equityAdvancing Equity, Diversity, and Inclusion Through the Transformation of Nursing EducationConnections and Biases in Health Equity and Culture Research: A Semantic Network AnalysisAppraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations April 2021Volume 174, Issue 4Page: 548-549KeywordsAlgorithmsArtificial intelligenceCOVID-19Firearm injuriesHealth careHealth care facilitiesHealth disparitiesHealth equityPerceptionPrevention, policy, and public health ePublished: 2 February 2021 Issue Published: April 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. 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