You might have supposed that trust in the medical profession would have risen as medicine became more effective at warding off death and disease, but you would have been mistaken. In fact, precisely the reverse has happened throughout the western world, but particularly in the United States. Half a century ago, nearly three quarters of Americans had confidence in the medical profession qua profession; now only about a third do so.
According to international surveys reported in an article in a recent New England Journal of Medicine, Americans are among the most mistrustful of doctors of any western people. Asked whether, all things considered, doctors in their country could be trusted, 58 percent of Americans answered in the affirmative; by contrast, 83 percent of the Swiss answered positively. Positive answers were returned by 79, 78, and 76 percent of the Danish, Dutch and British respectively. Americans were 24th of 29 nations polled in their trust of doctors. Furthermore, just fewer than half of Americans in the lowest third of the income range thought that doctors in general could be trusted, and younger Americans were also less likely to trust their doctors than older ones.
Curiously enough, though, Americans were among the most satisfied of nations with their last encounter with their doctor. Only the Swiss and Danes were more satisfied than they, and then not by very much (64, 61 and 56 percent respectively). In other countries, then, people were more likely to trust doctors in general than be satisfied by their last visit to the doctor; in America, it was about the same proportion.
What, if anything, does this mean?
Opinion polls are notoriously unreliable even as reflections of opinion, let alone as predictors of behavior. The same question phrased differently can produce a very different or opposite answer; the same words mean different things to different people. But let us forget these quibbles, and take the results of the surveys at face value, and assume that people everywhere understood the questions asked in the same way.
Were the 58 percent of Americans who trusted doctors in general almost exactly the same people as the 56 percent who were satisfied with their last visit to their doctor? If so, did they judge the whole of the profession by their last personal experience of it? Clearly the Swiss did not, because nearly a fifth of them trusted doctors in general despite being unsatisfied by their last personal contact with their doctor. This might speak of a largeness of mind that recognises that personal experience is not an infallible guide to the reality of things, or it might mean that the Swiss are respectful of authority despite bad experience of it. The almost exact correspondence of the percentage of trustful and satisfied Americans might mean that they are completely egotistical, or completely rational, in their judgments.
One of the more interesting results of the surveys cited was that even the poorest third of Americans were, at 48 percent, relatively satisfied with their latest contact with doctors, as high a proportion as Swedes as a whole.
Satisfaction may be the end of all human activity, but is it a good guide to the actual efficacy of a health care system? Not long ago there was a survey by the Commonwealth Fund into the health care systems of the world, and – according to its measurements – the British, with their National Health Service, were the most satisfied people in the western world. It was curious, however, that while the British system scored best on all subjective measures, it measured worst, or near worst, on all objective ones except one (the results of diabetic care). Is nothing good or bad but thinking makes it so?