Clinician Mistrust in Patients: A Survey of Primary and Urgent Care Clinicians in Colorado

Eric Campbell – Center for Bioethics and Humanities – University of Colorado Anschutz School of Medicine; Christine Baugh – Center for Bioethics and Humanities – University of Colorado Anschutz School of Medicine; Matthew DeCamp – Center for Bioethics and Humanities – University of Colorado Anschutz School of Medicine; Lauren Taylor – Department of Population Health – New York University Grossman School of Medicine; Lindsey Fish – Department of General Internal Medicine – Denver Health and Hospital Authority; Matthew Wynia – Center for Bioethics and Humanities – University of Colorado Anschutz School of Medicine

Abstract: A robust literature exists on patient mistrust of clinicians, but only a few studies have examined clinician mistrust of patients. We surveyed all clinicians practicing at outpatient primary and urgent care clinics in a university health system and a safety net health system in Colorado (response rate 62.8%) to examine the nature, extent, and factors associated with clinicians’ mistrust in patients. Overall, 29.5% of clinicians reported “Sometimes,” “Often,” or “Always” mistrusting one of their patients; 65.0% reported that it was “Sometimes,” “Often,” or “Always” ethical for clinicians to mistrust their patients; and 42.9% felt mistrusting patients was “To a great extent” or “To some extent” a part of good medical practice. In a multivariable model, practicing in a safety net setting (OR 2.07, 95% CI 1.03–4.25, p=0.04) and feeling burned out (OR 2.51, 95% CI 1.02–6.48, p=0.05) were associated with higher odds of mistrusting patients, while spending less than 50% of professional time in clinical care was associated with significantly lower odds of mistrust (OR 0.20, 95 CI% 0.05–0.62, p=0.01). Among societal factors, the opioid crisis (73.0%) was most frequently viewed as contributing to clinician mistrust in patients, followed by political extremism (55.6%), patients using social media to criticize clinicians (55.2%), the litigious nature of the US (55.1%), and the COVID-19 pandemic (32.1%). Our findings provide insight into the clinician perspective of mistrust in patient-clinician relationships, highlight the importance of including this perspective, and suggest interventions to improve mutual trust.

Keywords: clinician mistrust, clinician survey