How to Revitalize Trust in Primary Care

Primary care providers can do much to rebuild patient trust and confidence, but it’ll take deliberate effort and a shift in ideals to make a change.

As a primary care physician, my belief in the practice only strengthens with time. I’ve fielded far too many patient encounters throughout my career to ever doubt its efficacy. It’s a fundamental component of preventive medicine at the very least—and a lifesaving intervention at its very best.

I’ll never waver from my commitment to the proven approach of primary care, though I do worry about its future. Nearly a third of U.S. patients did not see a PCP between 2016 and 2022. Young adults show little interest in having a PCP and prefer urgent care centers for their health services. And the idea that the annual physical is a relic of antiquated public health recommendations gains traction with each newly published opinion piece.

Then there’s the workforce and its projections, which are dire. Established PCPs are transitioning into new opportunities or retirement. Meanwhile, recent graduates are choosing not to become PCPs. Instead, they’re opting for specialties that provide greater administrative support, a less intensive workload, and a wage that they feel is more reflective of their education. It’s understandable—but not any less disheartening.

That’s just a glimpse into the odds stacked against primary care right now, with each point requiring a measured response if we hope to see the intervention return to its prestige. But recently, I’ve found myself reflecting on another critical issue affecting the reputation of primary care, especially among historically marginalized communities: the erosion of trust in the patient-clinician relationship.

Inequitable health care experiences and outcomes

People of color (POC) already face many disparities in health care. Everything from obesity to HIV impacts POC folks at higher rates than white folks. Hypertension, diabetes, cervical cancer, you name it: if we can quantify a condition, odds are we can find disproportionate outcomes that link back to race or ethnicity.

Worsening health outcomes among POC patients and the variables that influence those outcomes are the devastating consequences of systemic racism traced centuries ago yet continuing to hold communities back today. Health care plays a critical role in the solution, but given the startling results of national surveys, it’s failing historically marginalized communities.

A 2021 survey by the Pew Research Center showed that 55% of Black U.S. Americans reported at least one negative interaction with a physician or other health care professional. 35% reported that they felt their pain was not taken seriously by their clinician, while 32% reported feeling rushed during their appointment. That data reflects research from the Urban Institute, which found that Black and Hispanic or Latine patients were more likely to experience unfair treatment or judgment due to their race or ethnicity.

The Pew survey did have some positive findings to note. 61% of respondents reported receiving either “excellent” or “very good” care from a health professional recently. That’s certainly a promising sign that I hope to see more of in the coming years. Unfortunately, that experience varied by income: 73% of respondents who reported a positive experience were in a higher income bracket, while 66% and 55% were in middle- and lower-income brackets, respectively.

Perceived wealth or status and its connection to race or ethnicity may influence how clinicians treat their patients, which compels POC folks to present themselves in a certain manner to ensure adequate care. A KFF survey released in 2023 found that 55% of Black adults feel the need to be careful with their appearance before an appointment. Nearly half of respondents who identified as American Indian, Alaska Native, and Hispanic felt the same inclination. Only 29% of white respondents said they felt they had to consider their appearance. Unsurprisingly, that same survey showed large numbers of POC respondents reporting negative treatment.

Lack of representation in health care also influences the health care experience for POC patients. A 2022 survey found that Hispanic men were the least likely of all U.S. adults to visit the doctor, with language barrier an oft-cited reason. It turns out that the race, ethnicity, and shared experience of a clinician can matter a lot to Hispanic or Latine patients, as it does to other populations. It also affects health outcomes: research suggests that Black people in counties that have higher rates of Black PCPs have greater life expectancy rates. The difficult part is finding a physician of color, as less than 44% of all physicians in the U.S. are non-white.

Patients from historically marginalized communities seem to have lost their confidence in what health care offers. And why wouldn’t they? When you’re seen by a clinician who can’t relate to your experience – or even worse – judges you based on it, it’s no wonder why a person of color would hesitate to schedule an appointment. It’s enough for anyone to want to go on their health journey alone.

The good news is I think we’re at a point where health care in the U.S. is coming to terms with the disparities historically marginalized communities like POC or Hispanic and Latine patients endure. Discourse and education are helping clinicians nationwide recognize the interwoven threads of racism embedded deep in our society. Of course, microaggressions and microinvalidations occur, and that won’t change until we advance our collective consciousness. But I’m optimistic that it’s not too late to restore faith in the health care experience.

The role of PCPs in the healing process

So where does this leave primary care? I believe the advantages of the model that some may underestimate at times (e.g., annual physicals) are actually our greatest assets to alleviate the concerns of patients with traumatizing experiences. However, that can only happen with a shift in ideals. Clinicians and support personnel will need to understand and find the passion for dismantling the grip societal privilege holds not just in health care but in every institution in the U.S.

I don’t have all the answers, and I continue to learn myself. But I do have some thoughts on how I think each of us can aspire to be the clinician or advocate we genuinely want to be for our patients.

Check yourself. Patients depend on us because we’re expert evaluators, but are we as apt in self-evaluation? We need to notice bias whenever it manifests, which means becoming more aware of our thoughts. Everyone has implicit biases; we can’t stop that. However, it’s our response that matters. Think twice before you speak or act. Demand sensitivity and compassion out of yourself for the benefit of your patient. Your authority means your words echo.

Never stop learning. The pursuit of antiracism is a journey each of us needs to take. Some are further along, others a little behind, but in any case, we reach the destination through education. Stay informed by following organizations addressing pertinent issues involving race and class. Engage in open, respectful dialogue with people different from you. Step outside of your comfort zone. Make humility your priority.

Demonstrate your allyship. Your demeanor is the first indication of the safety of your practice, and that will always take precedence. But there are other ways to let folks from historically marginalized communities know you’re there for them. Participate in awareness days that celebrate populations or draw attention to disparities. Write a diversity, equity, and inclusion (DEI) statement and feature it prominently on your website. Hang up posters in your exam rooms that balance information with representation. Every deliberate action moves us closer to equity.

Community health can lead by example

Primary care would do well to reposition itself as the standard in health care, which means more practitioners, quality care, and a renewed promise to patients, particularly those who have endured inequitable care in the past. The paths to achieve as much are many, but I believe one of them lies in the example of the community health (CHC) movement, where the principles of preventive health are strong, and empowerment comprises every interaction.

The CHC movement has helped improve health outcomes using primary care as the foundation for nearly sixty years. While surveys routinely suggest problematic care and treatment in conventional health settings, CHCs offer an empowering experience for patients from historically marginalized communities. At CCI, the culturally competent and patient-centered care model we offer our over 37,000 patients (roughly 90% of whom are Hispanic, Latine, or BIPOC) resulted in 98% of patients surveyed reporting that they felt our clinicians listened to them.

Our near-total patient satisfaction with their clinicians is remarkable, but it didn’t happen by accident. It’s a deliberate decision to be a part of the solution—and it’s not out of reach for anyone willing to put in the work. Public health thrives when clinicians pursue greatness for their patients, regardless of who they are or what they’ve experienced. The future of primary care depends on our efforts, and generational health depends on primary care.