August 30, 2021

Let's Talk About Trust.


It’s often said to be an essential component to survival. Borrowing from Stephen M.R. Covey,i trust allows us to move and think with speed. It allows us to have fulfilling relationships. It allows us to offer inspiration. It allows our economies to be profitable. And its power to influence the course of events – for whole societies or individually, and especially for our health and well-being – rests in the trustworthiness of the source. 

Some days it feels like the importance and challenges of trust have never been more on display than during these past 20 months.

Last May, several industry news outlets covered a study conducted by NORC at the University of Chicago and commissioned by the American Board of Internal Medicine Foundation as part of their new initiative to elevate trust to improve health care.ii,iii Those surveys, conducted from January through early February, 2021, showed that the general public trusts doctors and nurses (84 and 85% respectively) more than hospitals (72%), the health care system as a whole (64%), or government agencies (56%); at the bottom of the list, pharmaceutical companies and health insurance companies (34 and 33%, respectively.) They also showed that, while trust stayed the same or increased for most consumers, 32% said their trust in the health care system decreased during the pandemic. Equally troubling is that roughly the same percentage of growing distrust occurred in physicians as it pertains to the health care system as a whole and specifically in health care organization leadership.

This information comes as no surprise to emergency physicians. If anything, all signs point to even more erosion of trust since February. Through conversations with ACEP’s chapters where COVID-19 cases are again surging, feelings of physical fatigue are compounded by severe emotional fatigue. Each patient encounter has the potential to be derailed by a lack of trust in what the physician is recommending. Interpersonal support from friends and family may be challenged by opposing views on vaccine mandates. Communities seem inspired more by the misinformation they seek to believe and resist the motives of those they don’t trust. It’s so disheartening.

Here's something else we know: Patients do trust emergency physicians. ACEP recently commissioned Morning Consult to conduct a similarly-sized poll among American adults, fielded between June 23-July 7, 2021.iv In it, we found that more than nine in ten (93%) trust an emergency physician to provide medical care in the event they went to the emergency department. Those adults also consider 24/7 access to an emergency department to be just as essential to their communities as fire departments or water utility services. And they most trust a physician to lead care in the ED, especially for more severe injuries and illnesses.

In looking at ACEP’s Code of Ethics for Emergency Physicians, I can see why trust between patients and emergency physicians is so integral.v Our code speaks of the unique relationship the emergency physician has with their patients this way:

“Emergency physicians typically have had no prior relationship with their patients in the emergency department. Patients often arrive in the emergency department unscheduled, in crisis, and sometimes against their will. Thus, emergency physicians cannot rely on earned trust or on prior knowledge of the patient’s condition, values, or wishes regarding medical treatment. The patient’s willingness to seek emergency care and to trust the physician is based on institutional and professional assurances rather than on an established personal relationship.”

It doesn’t stop there. Trustworthiness is one of the essential virtues of an emergency physician identified in our code:

“Sick and vulnerable emergency patients are in a dependent relationship; they must rely on emergency physicians to protect their interests through competence, informed consent, truthfulness, and the maintenance of confidentiality.”

These are very difficult times. Lack of trust in health care systems is slowing your ability to act and think with speed. It is making it harder to offer inspiration and work as one. It is leaving many feeling that the systems designed to help are actually failing them.

But I don’t believe it is leaving us so empty that we can’t influence the course of events. I have spoken with many emergency physicians who, at the end of a long shift, still find it important to answer emails or get online to spread trusted information. Many of you are helping ACEP remain vigilant in our efforts to raise awareness and find solutions for the system challenges you are facing, meeting with hospital associations, accreditation entities and Federal regulators to stop these systems from failing.

We need to keep spreading real information to combat the misinformation about COVID. If you have a story about how shared decision-making worked to gain a patient’s trust, we want to hear about it. We want to celebrate and build upon these moments.

We are [still] in this together. The relationships we have with each other, within our communities and with every patient visit, are influencing the course of events, through trust.

Now, let's get to the updates:

ICYMI: We are hearing from many of you that ED boarding is at an all-time high. In his recent regulatory blog, Jeff Davis talks about this complicated issue and how ACEP is working to support you.

Also – have you checked EM Careers lately? There are more than 250 jobs posted.

NOW: ACEP President-Elect Dr. Gillian Schmitz recently recorded a new Workforce Minute explaining recent progress and highlighting the data around the growth of residency programs vs. attrition, how residency programs are created, and updates on the five pillars. If you’re catching up on EM Workforce progress, you can also watch the Workforce Town Hall from LAC21 or this recent panel discussion hosted ACEP’s Young Physicians Section where they asked questions submitted by their members.

NEXT:  We’re two months away from ACEP21 in Boston, and we know you have questions. Your staff and elected leaders are in constant conversations about the event, with health and safety as our top priority. Right now, ACEP is holding out hope for a face-to-face meeting in Boston. No one understands better than your peers what this year has been like for you. Many of our members have expressed a real need to be together for support, encouragement, and rejuvenation. In a recent survey of current registrants and some past attendees, opinions were split: 50% wanting to come to Boston, 50% feeling ACEP should shift to a virtual event. Unfortunately, there is no definitive timeline for making this kind of decision. We are committed to ensuring we host an in-person meeting safely and responsibly. If we cannot do that, we will shift to virtual. We’ll continue to provide updates as the situation evolves. View the latest safety protocols.


Sue's Shout-outs

August was a blur of a month filled with a lot of disaster and hardship. On top of the pandemic, many regions are navigating unexpected challenges: Hurricane Ida, the Afghanistan evacuation, Haiti's earthquake , wildfires, flooding, heat waves and political unrest. We send our heartfelt thanks and appreciation to our members in these areas who are managing dual disasters. We can only imagine how hard it is. We admire and appreciate you. 



[i] Covey, Stephen MR. The Speed of Trust: The One Thing that Changes Everything. 2006.
[v] /siteassets/new-pdfs/policy-statements/code-of-ethics-for-emergency-physicians.pdf
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