Trustand Mistrust in Health Care
Trustand Mistrust in Health Care
Medicalresearchers have found out that the community of African- Americanshas a tendency of mistrusting doctors and other physicians. Theoutcome of this mistrust is increased number of people fromAfrican-American community who do not seek medical treatment(Harrison, 2003). A few people from the African-American communitywho seek medical treatment do it late and this leads to higher costsof treatment and sometimes the medicine fails to work because thedisease has already developed. Many scholars from the medical fieldbelieve the Tuskegee Syphilis Experiment is the main contributor tothe growing mistrust of physicians by African-American community.Some scholars from other fields have also carried out researches todetermine factors that have contributed to the mistrust of physiciansby the black Americans. This paper outlines the history of TuskegeeSyphilis Experiment, implications of the experience, actions ofmistrustful patients and other historical events that affectpatient’s willingness to treatment (Rose,2004).Discussion Tuskegee SyphilisExperiment was a clinical study undertaken in the US between the year1932 and 1972. The study conducted by United States Public HealthService aimed to determine the progression of natural untreatedsyphilis among the African- American community men. The main reasonthe public health service opted for African-American men was becausethe majority of them used to live in a rural area, they were poor,and thus they could not afford health care. In 1932, the publichealth service joined hands with Tuskegee Institute (historicallyblack college) which later became Tuskegee University to administerthe study. The investigators from both parties enrolled a total of600 black men from Alabama to carry out the study. Out of the 600,399 had contracted syphilis before while the remaining 201 had nevercontacted the disease before. The men’s motivation to participatewas as a result of the promised benefits such as meals, free medicalcare, plus free burial insurance (Gray, 2013). One of the mostunethical things that happened during the study was that the patientswho suffered from syphilis were never informed they had the disease.To make the matter worse, the investigators did not treat therespondents who were suffering from syphilis yet they knew about itsexistence. Instead, the respondents were informed that they werebeing checked for “bad blood," a disease that involves variousillnesses such as syphilis, fatigue, and anemia (Gibbons, 2008).Throughout 1940’s, doctors were seriously looking for a syphiliscure and in 1947 they discovered that the penicillin can cure thedisease. However, even after discovering that syphilis is curable,the investigators of Tuskegee syphilis experiment did not treat theenrolled patients raising more ethical concerns. The study took fortyyears and during this time, many of the respondents lost their livesyet a cure for their disease was available. When whistleblowersraised concerns about the failure of the study in 1972, many legalchanges were made regarding the protection of respondents in clinicalresearch (Gilson, 2003). Ever since the Tuskegee syphilisexperiment, many regulations and federal laws requiring humansubjects used in clinical studies to be protected were introduced. Inaddition, many black patients in the United States startedmistrusting the health care system (Hall, 2001). Recent studiessuggest that individuals who do not trust the health system have ahigher chance to postpone treatment leading to worsening of theircondition and sometimes increased treatment cost. Tuskegee syphilisexperiment also brought the issue of racial disparity in healthsystems. The African-American community developed a notion that thewhite physicians were mistreating the black Americans (Boulware,2003). Lack of trust on the physicians also makes patients morelikely to make malpractice accusations or ignore the recommendedtreatment plans leading to weaker patients and higher costs. Inshort, mistrust in health system is associated with no adherence,delay in care seeking, and failure to keep assignments (Sillence,2004). Physicians can learn of the mistrust by the patientthrough various indications. First, failure of a patient to honor anappointment may indicate a lack of trust on the part of the patient.Secondly, if a patient cannot take the medicine as prescribed by aphysician, chances are high the patient does not trust the physician.Finally, patients who keep arguing with the doctor or disagree withmost of the doctor’s instructions are likely to have developedmistrust towards the health system. Researches show that there areother historical events that may have led to the mistrust of African-American towards the health system. In the 20th century, there was asimilar study that was conducted parallel with Tuskegee syphilisexperiment, which harmed human subjects that participated in theexperiment unknowingly. A certain experiment carried out in Guatemalainfected subjects with sexually transmitted infections (Brandon,2005).Conclusion Mistrust in health care is commonespecially among African-American community. Tuskegee syphilisexperiment that lasted for forty years is said to be the maincontributor of the mistrust although there are other contributorssuch as the Guatemala experiment. Due to the mistrust, manyAfrican-American patients do not follow physician’s instructionswhile others fail to visit a health centre when they are ill. Medicalresearchers should conduct more studies to determine other factorsthat give rise to patients mistrust (Whetten, 2006).
Boulware, L. (2003). Race and trust in the health care system. Publichealth reports 118(4), 358.
Brandon, D. (2005). The legacy of Tuskegee and trust in medical care:is Tuskegee responsible for race differences in mistrust of medicalcare? Journal of the National Medical Association 97(7), 951.
Gibbons, M. (2008). EHealth solutions for healthcare disparities.New York: Springer.
Gilson, L. (2003). Trust and the development of health care as asocial institution. Social science & medicine, 56(7),1453-1468.
Gray, F. (2013). The Tuskegee Syphilis Study: the real story andbeyond. Montgomery, AL: NewSouth Books.
Hall, M. (2001). Trust in physicians and medical institutions: whatis it, can it be measured, and does it matter?. Milbank Quarterly,79(4), 613-639.
Harrison, J. (2003). Rebuilding trust in healthcare.Abingdon, U.K: Radcliffe Medical Press.
Rose, A. (2004). Development and testing of the health care systemdistrust scale." Journal of General Internal Medicine19(1), 57-63.
Sillence, E. (2004). Trust and mistrust of online health sites. InProceedings of the SIGCHI conference on Human factors in computingsystems (pp. 663-670). New York: ACM
Whetten, K.(2006). Exploring lack of trust in care providers and the governmentas a barrier to health service use. American Journal of PublicHealth, 96(4), 716.