Thursday, October 23, 2014 US Ranks Near Bottom in Level of Trust in Medical Profession; Near Top in Personal Satisfaction With Treatment It's accepted wisdom that 21st century Americans generally mistrust Congress but feel good about their own representatives. Apparently, the same seemingly paradoxical views are true for the medical profession, and in a big way—the US ranks near the bottom among 29 countries in level of trust in the overall medical system, and near the top in satisfaction with individual care. A study published in the October 23 issue of the New England Journal of Medicine (summary available for free) reports on polling data that show a dramatic drop in Americans' confidence in the medical profession between 1966 and 2014. The decline is significant: in 1966, nearly 3 quarters (73%) of Americans expressed "great confidence in the leaders of the medical profession," but that rate is now 34%. Americans' lukewarm level of confidence in the medical profession in general puts the US near the bottom of 29 countries surveyed from 2011 to 2013, tied for 24th place with Croatia in terms of the percentage of respondents who agreed with the statement, "All things considered, doctors [in your country] can be trusted." A total of 58% of Americans agreed, putting the US behind countries such as the Philippines (#17), Turkey (#5), and Portugal (#16). Switzerland ranked highest in this category, with an 83% rate of agreement. Only Chile, Bulgaria, Russia, and Poland scored lower than the US. But in a shift that authors describe as "unique among the surveyed countries," Americans tend to rate their satisfaction with their own medical treatment higher than all but 2 other countries, with 56% of American respondents reporting that they were "completely" or "very" satisfied with their last visit to a physician. Switzerland had the highest rate (64%), followed by Denmark (61%). Lithuania (13% rate) and Russia (11% rate) were at the bottom of the list. Authors note that the rate of institutional trust and personal satisfaction tends to be similar in nearly all countries, and that the US is an "outlier." Authors of the study write that the lack of trust in the medical institution puts doctors at risk of losing political clout as the future of US health care is shaped. "If the medical profession and its leaders cannot raise the level of public trust," they write, "they're likely to find that many policy decisions affecting patient care will be made by others, without consideration of their perspective." Authors suggest that public trust could be improved "if the medical profession and its leaders deliberately take visible stands favoring policies that would improve the nation's health and health care, even if doing so might be disadvantageous to some physicians." Other findings in the study related to Americans' perceptions: Mistrust of the medical profession is lower among low-income families (47% rate of trust) compared with families not considered low-income (63% rate of trust); however, individual satisfaction was relatively stable across the groups. Americans 65 and over were more likely to agree that doctors can be trusted (69%) compared with those under 65 (55%). Men tended to express more trust than women (63% vs 54%).