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Among the things I cherish most about leading a marketing research company while continuing to moderate one-on-one interviews myself is the privilege of hearing the conversations that shape healthcare long before they appear in headlines, conference presentations, or industry reports.
There is something uniquely revealing about sitting across from a physician, patient, or caregiver and listening to what is actually on their mind. In an era increasingly captivated by AI-generated insights, synthetic (or simulated) respondents, and digital proxies for human behavior, I am reminded daily that there is still no substitute for a real conversation with a real person. After three decades of doing this work, those moments remain as illuminating, and refreshing, as ever.
Recently, I was assisting one of my colleagues in conducting a series of 1:1 in-depth interviews with US pediatricians about childhood vaccination. I began each conversation the way moderators often do, with an intentionally broad opening question: “What’s happening in your practice these days? What trends are you seeing?” What stood out was how consistently the same theme surfaced. Before we ever discussed vaccines, market dynamics, or treatment decisions, many physicians were already talking about trust.
Or more precisely, the growing absence of it.
Several pediatricians described spending increasing amounts of time addressing parents' concerns about routine childhood vaccinations. What struck me was that these were not conversations about newly developed vaccines, evolving evidence, or emerging safety questions. They were discussions about vaccines that have been part of pediatric care for decades, vaccines whose safety and effectiveness are supported by an extraordinary body of scientific evidence accumulated over generations. Yet many physicians found themselves re-litigating questions they thought had long since been settled.
Many physicians recounted stories about parents arriving with information gathered from social media, online forums, influencers, and websites of varying credibility. Others described spending valuable appointment time correcting misinformation or explaining why a claim a parent had encountered online was not supported by evidence. One pediatrician told me that conversations which once took a few minutes can now consume a significant portion of an office visit. Another shared that their practice had adopted a stricter policy: families unwilling to follow recommended vaccination schedules would no longer be accepted into the practice.
What became increasingly clear over the course of these interviews was that trust, or more accurately, the erosion of trust, was no longer a philosophical concern or a public health talking point. It had become a daily operational reality for physicians, consuming time, shaping patient interactions, and influencing how care was delivered.
This wasn't an abstract societal issue. It was affecting how physicians allocate their time, how practices establish policies, and ultimately how care is delivered to patients.
As I reflected on those interviews, I was reminded that healthcare runs on trust in much the same way that a city runs on electricity. We rarely notice it when it is working. We all notice it immediately when it begins to fail.
Trust is the invisible infrastructure beneath nearly every interaction in healthcare. It allows a patient to accept a difficult diagnosis. It allows a physician to recommend a treatment. It allows researchers to recruit participants into clinical trials. It allows public health officials to guide communities through crises and pandemics. And it allows pharmaceutical companies to communicate science in ways that patients and healthcare professionals are willing to hear.
For decades, our industry has focused on innovation, access, affordability, and outcomes. Increasingly, however, trust may be emerging as the defining challenge that connects all of them. Recent findings from Medscape's ongoing examination of trust in medicine suggest that what I was hearing from pediatricians is not an isolated phenomenon.
Nearly half of physicians surveyed (44%) reported that patients' trust in their treatment recommendations has worsened over the past several years. Yet at the same time, 88% said their patients still trust them personally.
That distinction may be one of the most important findings in healthcare today.
One of the most enduring observations in social science is that people often continue to trust individuals even as their trust in institutions declines. Healthcare increasingly appears to be following this pattern.
The Medscape findings point to this growing divergence. While physicians largely believe that patients continue to trust them personally, confidence in the broader healthcare ecosystem appears considerably weaker. Only 18% of physicians surveyed expressed trust in federal regulators to craft policies grounded in strong scientific evidence. Seven in ten questioned whether reimbursement decisions are fair and evidence-based.
For patients, however, these distinctions are not always neatly separated.
Healthcare is experienced as a single ecosystem. Insurance denials, appointment delays, contradictory media narratives, public policy debates, staffing shortages, and online misinformation often blend together into one cumulative experience. Over time, these experiences shape trust in the system itself.
It is tempting to attribute declining trust solely to social media and misinformation. Certainly, they are important contributors. But focusing exclusively on misinformation risks missing the deeper forces at work. Trust tends to weaken when systems become difficult to navigate, difficult to understand, or difficult to believe are acting in one's best interests.
Patients today face an increasingly complex healthcare environment. They interact with providers, insurers, health systems, regulators, pharmaceutical manufacturers, advocacy organizations, digital platforms, and now artificial intelligence tools -- all generating information that may or may not align.
The result is often confusion rather than clarity. In such environments, certainty can become more persuasive than expertise.
That creates fertile ground for misinformation, but it also reveals a broader systems challenge that extends far beyond any single platform or technology.
As if healthcare were not complex enough, genAI is introducing an entirely new dimension to the trust conversation.
Recent reporting from Medscape highlights a growing disconnect: patients generally trust their physicians, but many remain unaware of how AI is increasingly being incorporated into healthcare delivery, from clinical documentation and diagnostic support to administrative workflows. Questions about transparency, accountability, and consent are becoming increasingly important. As one expert observed, healthcare organizations must earn trust in AI rather than simply assume it exists.
The challenge is not whether AI will become part of healthcare. It already has. The challenge is whether healthcare organizations can introduce these technologies in ways that strengthen trust rather than inadvertently weaken it.
For those of us working in pharmaceutical marketing, commercial strategy, I&A, and communications, these developments carry profound implications. Historically, we have focused on awareness, education, engagement, and behavior change. Yet every one of these objectives depends on a fundamental and foundational ingredient: credibility.
Trust acts as a multiplier.
When trust is high, educational content is more readily accepted. Scientific evidence receives a fair hearing. New therapies are evaluated on their merits. Conversations between patients and healthcare professionals become more productive.
When trust is low, every message faces additional resistance. Every claim requires greater validation. Every communication must work harder to establish credibility before it can deliver information.
This suggests that trust-building may increasingly become as important as message optimization.
Transparency, consistency, empathy, scientific rigor, acknowledgment of uncertainty, and visible patient-centered intent may no longer be communications best practices. They may become strategic necessities.
The encouraging news is that trust has not disappeared. The physicians I interviewed still care deeply about earning it. Patients still seek it. The physician-patient relationship remains one of the most trusted relationships in society. But trust is not owned by any single stakeholder.
It is a shared asset.
Physicians contribute to it. Researchers contribute to it. Regulators contribute to it. Health systems contribute to it. Pharmaceutical companies contribute to it. And patients contribute to it as well.
When trust is abundant, education becomes easier, innovation is more readily adopted, and healthcare functions more effectively. But when trust is scarce, everyone works harder.
The pediatricians I interviewed reminded me of that reality. They were not simply discussing vaccines. They were describing (lamenting, actually) the daily consequences of a healthcare system operating with a smaller reserve of trust than it once had.
For those of us responsible for communicating science, generating evidence, and helping patients make informed decisions, rebuilding that reserve may be among the most important challenges -- and opportunities -- of the coming decade.
