Study: Trust in personal doctors divided along political lines

Democrats are more likely to trust their personal doctors and follow their doctors' advice than Republicans, new research from the University of Oregon finds.

UO political scientist and 2024 Andrew Carnegie Fellow Neil O'Brian co-authored the paper with independent researcher Thomas Bradley Kent. It recently appeared in the British Journal of Political Science.

The findings have implications for personal and public health, as well as the practice of medicine in the United States.

Patients who trust their doctors are more likely to follow their doctor's guidance on everything from managing diabetes to getting regular colon screenings, which improves health, various studies have shown.

The big takeaway from our research is that after the COVID-19 pandemic, not only are the left and right divided on COVID-19 health matters, they're also divided on trust in their own doctor and following their doctor's advice about their health conditions. This broader polarization about trust in medicine has trickled down to trust in your personal doctor to treat, in some cases, your chronic illnesses."

Neil O'Brian, UO political scientist and 2024 Andrew Carnegie Fellow 

That's alarming because life expectancy has stagnated in the United States and declined in the early 2020s, O'Brian said.

Between 2001 and 2019, scholars also identified a growing gap in death rates between people living in Republican and Democratic-leaning counties. Residents of Democratic counties were living longer.

"If people don't trust medical institutions or health professionals, then it makes it harder to solve health problems and could potentially exacerbate them," O'Brian said.

Historically, politics has influenced health policy debates on topics like reproductive rights or government-sponsored health insurance. But the doctor-patient relationship stayed above the political fray, according to the survey data. Trust in one's doctor was bipartisan. Republicans had just as much trust in their personal doctors as Democrats.

When the COVID-19 pandemic emerged in 2020, O'Brian saw people take sides along party lines on public health measures like vaccines and masking. He wondered if the division also affected people's trust in their own doctors and their willingness to follow their doctors' recommendations on a range of health conditions. So he began to investigate.

O'Brian and Kent examined cross-sectional data, a survey of a slice of the U.S. electorate at various points in time. They found that Republicans and Democrats shared a trust in their doctors until 2020, when Democrats began to show more trust in their doctors than Republicans.

The researchers then sought to better understand why people's attitudes had shifted.

To test the role the pandemic may have played in shifting attitudes, the researchers simulated the divisiveness of the pandemic in an experiment involving 1,150 survey participants.

They randomly showed a group of respondents a New York Post headline charging that Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, was a Democrat. Then they asked the respondents about their trust in their personal doctor.

The group that saw the headline was more polarized along party lines, with Democrats reporting more trust and Republicans reporting less trust, compared to the control group that didn't see the headline.

Surveys of public trust in major institutions like the press, business and labor unions identified a division along party lines in the 2010s. One exception was medicine, but in 2020 a similar partisan divide also emerged in that institution, O'Brian said.

"We argue that the partisan divide in trust in personal doctors was a response to COVID-19, a COVID spillover effect," O'Brian said.

Next, the researchers investigated how much a doctor's political affiliation mattered to patients. It turned out to carry a lot of weight.

In their first experiment, the researchers created two fictitious profiles of dermatologists and randomly varied different attributes, such as race, gender, school attended, online ratings and political affiliation. Asked which dermatologist they were more likely to visit, both Republican and Democratic respondents preferred a doctor who shared their political beliefs.

In the second experiment, the researchers observed how 777 study participants responded when they saw doctors' profiles in Zocdoc.com, a directory of doctors, or profiles in conservativeprofessionals.com, a directory of conservative professionals, including doctors. Conservative respondents who saw conservativeprofessionals.com were more likely to seek health care from that website compared to those who saw Zocdoc.com

O'Brian's future research will explore the factors that inspire patients' trust in their doctors. He also will investigate what the trust gap in doctors means for health outcomes and if the data show different health outcomes for Republicans and Democrats.

Last May, O'Brian, an assistant professor of political science in the UO's College of Arts and Sciences, was honored as a 2024 Andrew Carnegie Fellow. The fellowship's $200,000 grant will help fund his future research on trust in doctors.