What Happened to Marcus Welby?

CHW LogoA few years ago, when a poll was released showing that Congress’ approval rating was at an all-time low of 9%, several commentators pointed out that it was substantially lower than Stalin’s approval rating in Russia.  Which provides a little context around a recent study supported by the Robert Wood Johnson Foundation and reported in the New England Journal of Medicine.  It showed that in response to the question, “All things considered, doctors in [your country] can be trusted,” only 58% of Americans agreed.  This placed us 24th of 29 countries surveyed, just above the former Stalinist countries of Bulgaria, Russia, and Poland.

Ouch.

This represents a significant decline from the 1960s.  It parallels a general distrust of the health care system (23% approval).  Interestingly, Americans are much more satisfied with their own doctor (ranked 3rd internationally) than with doctors in general, which mirrors the pattern of opinions about Congress as a whole (low approval) vs. one’s own representative (much higher).  Why the growing distrust of the medical profession?  Some of it is undoubtedly reflective of a generalized trend away from traditional deference to authority.  (I have no data to support this, but I’d guess there is an erosion of trust in the Encyclopedia Britannica, too.)  There has also been a de-deification of physicians.  Think of the contrast between Dr. Welby and Dr. House.  But another clue may come from looking at the results broken down by income.  Americans with above-average income rated doctors’ trustworthiness higher than those with below-average incomes.  This pattern was not seen in other countries.  Another study in the same issue of NEJM showed that access to healthcare is also sharply lower for low-income Americans, another disparity not seen elsewhere in the world.

Unfair as it may be, it seems likely that as Americans face more barriers to care due to rising cost and our lack of universal coverage, they are taking it out on all those who are seen to be benefitting from the system, including, unfortunately, doctors.  This is exacerbated by stories like the one in the New York Times about the unexpected bill for $117,000 for an assistant surgeon, or one of my buddies getting an $18,000 bill for his wife’s cataract surgery from a doctor he had never heard of.  Unfortunately, we physicians are seen as no better than those Party leaders who benefitted under Communism.  Or – gasp – than Congress.

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