Why standards matter

As medicine becomes politicized, trust in our physicians matters more than ever. High professional standards help them earn it.

Tara Montgomery is Founder & Principal of Civic Health Partners, an independent coaching and consulting practice that helps leaders reflect on trust and develop public engagement strategies that are worthy of trust. She is a volunteer Public Member of the Board of Directors of the American Board of Medical Specialties.

 “How can I find a doctor I can trust?” I keep hearing this question—from those feeling confused about a vaccination decision to those looking for an ob/gyn who shares their personal values. There’s unprecedented angst, uncertainty, and mistrust. During two decades as a patient and citizen advocate, I’ve encountered the mistrust that arises when systems that are supposed to protect us cause harm. I’ve learned that trust is an asset our health system cannot do without. It is at the heart of our relationships with our physicians and care teams and an essential foundation for the institution of medicine. Yet as our social fabric continues to fray, even the most trusted relationships come under strain. Our relationships with our physicians feel more fragile when the practice of medicine is politicized, and misinformation compounds our uncertainty and confusion about our health choices. 

As an independent volunteer public (non-physician) member of the Board of Directors of ABMS (the American Board of Medical Specialties), a nonprofit organization that oversees the standards for physician certification across 24 medical specialties (the American Osteopathic Association is another), I have a window into what happens inside the network of institutions that oversee the practice of medicine in the United States. The medical profession is dealing with its own trust challenges as it negotiates the tensions between freedom, regulation, and professionalism. In recent months, certifying boards have taken further steps to uphold their accountability by addressing unprofessional behavior and pledging to withdraw or deny certification to physicians who publicly share information that is directly contrary to the prevailing medical evidence.

While some physicians are uniting to defend their ability to take care of their patients and protect those patients’ reproductive freedom and bodily autonomy, others are asserting a questionable freedom to prescribe unproven treatments or disseminate misinformation that leads to medical harm or death. Some physicians are rejecting the institutions that enact and enforce standards of performance and conduct and oversee physicians’ accountability to the public. Efforts by these institutions to overcome mistrust should be welcomed. Self-regulation is a privilege that makes physicians accountable to their peers and importantly, the public. It is grounded in a set of agreed-upon standards and behaviors based on a common set of values and ethical commitments. It represents a social contract between physicians and the community that includes a promise to put the interests of patients first. 

But when mistrust in institutions manifests itself as legislative interference in that professional self-regulation, the politicization of the practice of medicine becomes an assault on medicine itself. The assault is already happening in states where state legislatures have told the state boards that license and regulate physicians that they may not take disciplinary action against physicians who disseminate misinformation or disinformation about COVID-19, vaccination, or scientifically valid treatments. The effects are harmful to physicians, nurses, and patients alike. In some states, physicians no longer have the freedom to provide the care they are trained to provide.

As patients, we are left wondering who we can turn to as trusted navigators as we make sense of our medical choices. As medicine becomes politicized, the answer to that initial question “How can I find a doctor I can trust?” is not as simple as reading patient reviews or going to a top-rated hospital. It’s important to know how to recognize a physician who has gone through rigorous and objective assessment of their knowledge, skills, judgment, and competencies.

The fourteen years I spent with the nonprofit Consumer Reports taught me to recognize a rigorous testing process and the ways it helps to build trust. That rigor is critical for the process of physician board certification. I’ve been reassured to find it at the American Board of Medical Specialties and its member boards: the research underlying every step, the collaborative process of standard-setting, the scientific methods that inform assessments, the secure examinations, the evaluation of ethics and professionalism, the verification that a physician is clear of any professional wrongdoing, the requirement to contribute to improving health and health care, and the cycles of continuing certification to stay current and maintain competency throughout a physician’s career. As a result, specialty board certification is one of the strongest signals that we can trust our physician. It represents a commitment to both learning and accountability.

Patients choosing a physician for themselves or loved ones would be wise to check online if a physician is currently board-certified. But if we want to help build a culture of trust in medicine, based on facts and not ideology, there are things we need to do as citizens to push back against the assault on the medical profession as well. We can communicate our support to elected representatives and candidates who oppose legislative interference in the practice of medicine and its self-regulation. As civic-minded community members, we can ask to be appointed as “public members” of the state boards that regulate medical practice or join a local hospital board as an advocate for patient safety and physician wellbeing. We can run for school boards where we can participate as champions of science education and children’s health. Civic engagement is as critical for building trust in medicine as it is for strengthening our democracy.

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