Internet, lack of trust threatens patient-doctor bond

GAINESVILLE, Fla. — Physicians have worked to earn the trust of their patients for nearly 2,400 years, dating back to the days of Hippocrates, the father of Western medicine.

Lucky for Hippocrates that his patients didn’t have internet access.

A new study published today by University of Florida Health researchers suggests that distrust of the health care system, including government health agencies, is seeping into the doctor-patient relationship and threatening the delivery of care.

The study noted that people with low trust in the health care system are more than six times more likely to say their interaction with a doctor worsened after they brought information from the internet to their medical visit.

The correlation remained true regardless of a patient’s political leaning.

Study lead author Arch Mainous, Ph.D., a professor and vice chair of research in the UF College of Medicine’s Department of Community Health and Family Medicine, said many patients turn to social media, online forums or self-described experts who often espouse misinformation.

“It really comes down to trust,” Mainous said. “This is not explained by politics.”

These individuals then arrive at appointments, he said, expecting their doctors to validate what they found online. When that leads to disagreement, Mainous noted, their relationship suffers.

“We have treated trust in the health system or in government health agencies and their advice as being a silo different from the patient-doctor relationship,” Mainous said. “What our study shows is that distrust can infect this in-person relationship, too. And when that trust falters, it’s going to affect the delivery of health care.”

The study, published in Frontiers in Medicine, analyzed national survey data from more than 2,500 adults who had discussed health information they had found on the internet with a medical provider in the prior year. Respondents to the National Cancer Institute’s 2024 Health Information National Trends Survey provide a representative sample of U.S. adults.

The study noted that only a third of those surveyed said they had “a lot” of trust in the health care system. Those reporting low trust were much more likely to say their interaction with a doctor worsened after looking up online medical information.

“If they don’t trust one source of information, then they’ll turn to another,” said Mainous.

Among patients with high trust, only 3% reported that their doctor-patient interaction worsened after discussing online information with their doctor. But among those with low trust, that number jumped to 17%. Low-trust patients were also significantly less likely to report that their doctor was open or respectful during the conversation.

Mainous said results signal a shift that physicians cannot ignore. Even if the information a patient finds is inaccurate — and the study did not attempt to judge the accuracy of that material — doctors must now navigate those conversations in ways that preserve their relationship with the patient.

Mainous emphasized that it is not improper for a patient to be engaged in their medical care and to seek information online.

“They may have found an article or a testimonial that says a treatment doesn’t work,” he said. “But it’s up to the doctor to say, ‘I hear you. Let’s talk through why the treatment I recommend is the best for you.’”

Doctors must listen respectfully and with empathy, a skill Mainous said most already possess.

Patients still largely trust their personal doctor, he noted. But that trust is no longer protected from broader skepticism about the health system. And if the trend continues, Mainous said, doctors might one day face even stronger headwinds.

“The patient-physician relationship is so critical to delivering quality health care,” Mainous said, “that we cannot ignore it.”