I Trust You, But I Don’t Trust the System: The Healthcare Trust Paradox and What It Means for Patient Experience

This transcript was generated automatically and may contain errors.

Melissa Gilkes-Smith: Three out of four Americans say their personal doctor is the most trusted voice in their health care decisions. That number holds across every political ideology, liberal, moderate, conservative. No agency, no institution, no presidential endorsement comes close. And yet 42% of those same Americans deliberately acted against their clinician’s recommendation in the past year. Not because they distrust their doctor, because they don’t trust the system their doctor works inside. That is the healthcare trust paradox. And it is not just a communications problem or a policy problem. It is a patient experience problem. And today we’re going to talk about what we can actually do about it. I’m Melissa Jilk Smith.

This is Touch Points, Moments That Matter. Let’s get into it. Today’s episode is a little different. We are leading with data. Specifically, we are leading with the findings from the 2026 SACS Health Influence Index, a national survey of 2,500 American adults that measures the disconnect between who Americans consider influential in healthcare and who they actually want to have influence. And it surfaces some findings that I believe every patient experienced professional, healthcare administrator, clinical leader, and practice owner needs to sit with. My guest today is the person who built the research. Ryan Cohn is partner and chief strategy officer at SACS Media, a national public affairs and strategic communications firm, the founder of SACS Health, the firm’s specialized healthcare division.

He has spent nearly two decades advising health systems, pharmaceutical companies, patient groups, and industry associations on public affairs, advocacy, and crisis communications across more than 35 states and Washington, D.C. He has worked on some of the most high-stakes healthcare issues of the past two decades: Medicaid funding, ACA subsidies, PBM reform, rural health transformation, and he is a leading expert in AI, digital advertising, and how health narratives are shaped and shifted. Ryan, welcome to Touch Points.

Ryan Cohn: Thanks so much for having me, Melissa. It’s great to be here.

Melissa Gilkes-Smith: It’s great to have you. So before we get into the specific findings, set the stage for our listeners. What is the influence index? What question was it trying to answer? And what surprised you most about what you found?

Ryan Cohn: So we first started examining the overarching healthcare landscape last year, right after Washington passed the big beautiful bill. The healthcare debate was raging at the time. Talk about what role does the ACA and Medicaid and funding of everything and providers, how does it all work together? And I kept hearing from providers, from industry groups, from a lot of healthcare leaders who went into a lot of those debates thinking that they had influence, thinking that their seat at the table was strong and that they could tell the same story that they had always told in Washington and beyond. But then they finished that debate and it didn’t go anywhere near as well as they expected. And they had this moment, it was a little bit initially of deer in the headlights.

Oh my, what just happened? And then they went into the soul searching and going, hey, do people actually see us in the healthcare world as we think we see ourselves? Or do we have an issue around image and how we communicate? What is our perception? What is that seat at the table look like? And how do people actually want to hear from us well beyond Washington? What does that look like nationwide? So we started hearing these questions a lot and we set ourselves out to basically experiment. And so we listened, and like you said, we put out a 2,500-person national survey that asked a whole multitude of, not just one issue, but over 60 questions about how people perceive the healthcare system. How do they want their voices heard?

What voices do they want elevated within the national healthcare conversation? And what are those innate challenges that they’re experiencing, whether it’s within their physician’s practice, whether it’s at a hospital or with other interactions across the healthcare landscape? And we found some fascinating insights as a result of those surveys.

Melissa Gilkes-Smith: So let’s talk about the demographic real quick. What does that look like amongst the 2,500 Americans that you surveyed? Age, race, you know, um political affiliation.

Ryan Cohn: So we made sure across 2,500 Americans to create a very statistically significant sample. We were surveying all age groups. We were surveying those who came from different healthcare backgrounds, uh, some who are uninsured, some who were on ACA or private insurance. We’ve got Medicare, Medicaid populations, all different age groups. And we’ll get to some of the different age disparities or differences a little bit later, but we found some really fascinating differences there. But overall, we made sure that it was a full sample that is representative of the US population today.

Melissa Gilkes-Smith: Okay. So let’s talk about the trust paradox because I think it’s the most important and most actionable finding in the entire report. Here’s the data. Let’s start with the trust paradox, because I think it’s the most important and most actionable finding in the entire report. Let’s talk about the data.

Ryan Cohn: So here’s the number that we found so fascinating. In the past 12 months, 42% of Americans deliberately did something that their clinician told them not to do, or skipped something that their clinician told them to do. And when asked why, they told us it was because they did not trust the healthcare system. Not their doctor, but the system. At the same time, doctors are the most trusted voice we measured at 86%. Nurses are right behind at 83%, pharmacists at 77%, hospitals at 76%, insurers and pharmaceutical companies are all the way down at 45%. So the paradox is not that people distrust their doctor, because they don’t. They very much do trust their doctor. The paradox is that trusting your doctor is no longer enough to get someone to actually follow their advice.

Melissa Gilkes-Smith: So Americans are trusting their clinicians, but they suspect the system behind their clinician is not acting in their best interest. And that distinction is absolutely everything.

Ryan Cohn: Absolutely. And if you dive deeper into that 42%, because that’s that’s why I always hear from people well, okay, what does that really mean? 17% avoided or delayed a recommended treatment, 16% avoided a vaccine, 15% avoided a recommended test, 12% changed a medication dose on their own, 11% stopped a medication early, and 10% switched providers because they did not trust them. And the last one should get every practice manager’s attention. When one in 10 adults switched their providers in the past year over trust, that’s not a satisfaction score. That’s revenue that walked right out the door and never told you why.

Melissa Gilkes-Smith: The report describes it as active noncompliance, not passive skepticism. And that’s a deliberate behavior change. From a patient experience perspective, this is absolutely devastating because we spend so much energy at what happens inside the clinical encounter. It’s actually what patients focus on the most in their Google reviews. So provider communication, empathy, listening, and this data says that even when a patient has a trusting relationship with their provider, system distrust can just override what happens in that room. I mean, how do you even respond to that?

Ryan Cohn: Well, the best explanation that I have is what I’m calling the invisible hand of healthcare. So patients suspect that the advice that they’re getting has been shaped by forces that their doctor does not necessarily control outright. The medication might be the one that the formulary allowed. The follow-up plan might be whatever their insurer will cover. The referral has to be within the network. They’re not accusing their doctor of anything. They just no longer are certain that the advice is solely about them and their best interests. The doctor knows how to play the game, but knowing that there is a game in and of itself becomes a really significant issue of trust. And once that doubt is in the room, you can’t just fix it by telling people to trust harder.

You have to fix it by making the invisible hand visible, pulling back the curtain and being very clear about what the game looks like and why the doctor is playing it to begin with.

Melissa Gilkes-Smith: So can we jump into the demographic of those 42%, you know, of the Americans that deliberately acted against their clinicians’ recommendations? So what does that age range look like when they’re acting against clinician recommendations?

Ryan Cohn: So we find that when looking at the demographics, age disparities show up most as these two different worlds of healthcare. There’s the under 45 and the over 65. And how they interact with the healthcare system is even more different than what we saw in terms of political uh differences, for instance, or any other type of differences within the healthcare system and perceptions of people. Those who are over 65 see a very clear picture of the healthcare system. They trust their doctors way more than any other population out there. They also blame a lot of the issues of the system squarely on insurers and pharmaceutical companies. But for those who are under 45, they don’t trust their doctors nearly as much.

They have a much more fragmented view of the healthcare system. They’re a lot more skeptical, and they don’t put all the pieces together in the same ways as others. They’re hearing messages from a lot of different sources, and they’re still trying to frame what it all looks like, but it’s a lot more complex of a picture.

Melissa Gilkes-Smith: So I have a couple of questions here now. So do you think that so with the under 40 range, right? Under 40, under 45, you’ve spent less time in the healthcare system. You are just reaching the age where you’re starting all of your, all of your preventative screenings. Um, you are you’re you’re maybe doing a physical every year, but probably not, because the majority of Americans after the age of 18 just don’t do that anymore. Um but, you know, over 45, over 65, you know, you start to enter that preventative screening. And then over 65, you just have more healthcare visits now, more doctors. Do you think that’s part of the reason why that over 65 group or over 45 group have more trust with their clinicians?

Ryan Cohn: Absolutely. That’s exactly right. So when you have a lot more of those ongoing interactions, you’re being referred to a lot more specialists. Care coordination becomes so crucial for an older American population, and you have to trust your doctor. That becomes so imperative to how it all comes together.

Melissa Gilkes-Smith: And then going to communication. So, of course, the under 40 group, over 45, 45 to 65. And then you, of course, you got 65 and older, they’re receiving communication and receiving information in different ways. Over 65, you probably have less individuals who are on social media like TikTok, Instagram, Facebook. Um, I I don’t even know all of them that are out there at this point now. And then the under 40 group, you know, that is a high social media. Like we they grew up in the age of social media.

Ryan Cohn: Absolutely. So we see that about 40% of the information about healthcare that actually moves younger populations is happening through social media. Podcasts are a really big driver, also. So you have to realize as a clinician that what your patients are hearing, if they’re younger, especially, are not just coming from within the walls of your practice or within the standard traditional healthcare system overall, but they’re hearing it from such a wide variety of voices. Now, what’s helpful is that they still trust your voice above all others. You have to make sure that you’re using that voice to the full advantage, though. And I don’t think that most clinicians realize the persuasive ability that they actually have beyond just what medication they’re prescribing, but to propose new policy ideas or to help shape how their how their patients see the overarching healthcare landscape, it’s a really big opportunity that often goes untapped.

Melissa Gilkes-Smith: So one of the numbers here that I have, um, and correct me if my number is wrong, but insurers have 51% perceived influence, but only 25% of Americans think that they should have it. So the voices patients trust most are the ones that they hear from the least, and the voices they trust least are the ones that they hear from the most. How did we get here?

Ryan Cohn: So this is what we call the influence gap. And I find it so fascinating. We asked these two questions back to back. Which three groups in the healthcare ecosystem have the most influence over the public conversation about healthcare today? And then which three should have the most influence? Clinicians came in at 26% on you and 58% on should. That’s a 32-point gap, and it’s the widest of any group that we measured. Insurers run exactly the opposite direction. 51% have it, 25% should. Drug companies, 43% and 14%. So the public is telling us something pretty direct. The people holding the microphone are not the people they want holding it.

Melissa Gilkes-Smith: So let’s also talk about the accountability gap because the report surfaces something that I think hospital administrators and health system leaders need to hear very directly. Hospitals rank 20% for shaping the access conversation, but 24% of Americans blame hospitals when patients cannot get timely appointments. You’re being held accountable for something you’re not largely messaging on. Ryan, what does this tell us about the gap between what organizations communicate and what patients actually experience?

Ryan Cohn: So this is something I really want to highlight for your listeners. We asked who shapes the public conversation about access to care. And like you said, hospitals came in at 20%. But then we asked this completely different question. When patients cannot get a timely appointment, who do you blame? And hospitals got 24%, second only to insurers at 27%. Clinicians, by the way, took 20 21%. Now you think about where hospital communications are typically focused, it’s on quality, clinical excellence, safety, and they do find there. Clinicians owned the safety conversation at 32%, and hospitals are second at 27%. So hospitals are winning an argument that nobody is having, and they’re losing one that they’re not even in.

The public is holding them accountable for the ability to get in the door. And that is a thing that almost no one is talking about. It’s at the hospital level, and then it’s for clinicians. While people really trust their doctors, they blame their doctors for their inability to get past their office staff.

Melissa Gilkes-Smith: So the report opens with a framing that I think is the most important sentence in the entire document. What if the people Americans trust most in healthcare are the ones they hear from the least? That’s not just a rhetorical question, it’s a structural problem. And before we talk about solutions, I want to make sure our listeners understand just how fragile the current trust environment is. Only 52% of Americans trust the U.S. healthcare system to act in patients’ best interests. More than one in three actively distrust it. Ryan, when you look at that number, what does it mean for how patients are actually experiencing healthcare every day?

Ryan Cohn: It’s deeply concerning. I’ll say that. Now, I will point out that the single most credible communicator in American healthcare is probably standing in the hallways of a practice or a hospital right now. But no one has ever media trained them. No one’s ever asked them to write anything or put them in front of a camera. And we’ve built an entire communications industry around the voices that unfortunately the public trusts least. So we really need to elevate the right voices, the most credible voices, and to give them a bigger seat at the table to drive forward the health care change that we desperately need across our industry.

Melissa Gilkes-Smith: So the confusing information link is something the report identifies that I find particularly important. 71% of those who distrust the system say they encountered conflicting health messages in the past year compared to 58% of those who trust it. Confusing information and distrust are not separate problems, they compound each other. And that’s something every patient experienced professional should be paying attention to. When a patient receives conflicting information from different sources, their doctor, a website, a social media post, a news story, it doesn’t just confuse them. It actually just erodes their trust. And eroded trust becomes clinical noncompliance. How do you think about that chain?

What can we do about it?

Ryan Cohn: We all hear about this rise of misinformation, whether it’s through social media or more non-traditional news outlets. The patient is making these decisions based on such a wide variety of sources as sources of information. And when they hear all the disagreement, when they hear the confusion, it’s making it harder for our healthcare professionals to actually make a recommendation to them and for the patient to believe that what they’re actually receiving is what they need to do. Now, what’s fascinating for me is that when we looked a little deeper at the different subgroups who were most likely to have taken a trust-driven action. So the These populations within our American healthcare ecosystem, who because of this confusion or conflicting information or just overarching distrust of the healthcare system, that they are saying to their healthcare providers, I hear you, but I’m going to do something different or I’m going to be a lot more skeptical of what’s happening here.

Surprisingly, the top group is actually healthcare professionals themselves, not the general public, but the people who are working in the system. 73% have said that they have basically ignored or reversed course on their clinicians’ recommendations due to distrust in the system. That was mind-blowing to me. Now, granted, the more and more I talk about it to different healthcare professionals, suddenly they all say, oh, of course, because we see how it works within the system. We know the game that’s being played. We have to play it ourselves. And so we become that more distrusting of the system overall that we have to be the ones on the front lines of working within every single day. The other populations, by the way, that had an increase of this distrustful behavior were parents of kids under 18 at 60%, and then adults over 60 at 55%.

Melissa Gilkes-Smith: So I want to go back to the healthcare professionals. So basically what you’re saying is because they know too much, they have that dis that greater distrust.

Ryan Cohn: Absolutely. They know how the system works, they know how to play it themselves, and they’re taking everything that they hear with a grain of salt.

Melissa Gilkes-Smith: And that’s just that’s just crazy to hear. And then also, I mean, with all of this misinformation, how is a provider, how is a clinician, how is a practice supposed to even keep up? Because you have all of this social media, all of these, you know, um Google doctors that are out there that are, you know, pushing out some of this misinformation. It’s not like you can get into the clinical encounter and the patient sits down and as the provider, you say, so let’s go over the list of misinformation that you’re going to receive about this specific diagnosis that I’m about to give you. And here’s the list of thousands upon thousands of, you know, of information, of podcasts, of, you know, social media, you know, ads and just everything.

How do how do you even keep up?

Ryan Cohn: So it’s a little counterintuitive, but what we need to do more and more is show our work and pull back the curtain and explain what’s going on. Patients want to hear from their clinicians just how it works. They don’t want it glossed over. They want to be seen as partners in their care. And we can look at them and say, you know what? You know more than what some of us may think you do. We can trust you to have a legitimate conversation and say, look, I want to give you this one prescription. But unfortunately, we’re going to have to jump through some hoops first. Here’s what that looks like. I wish we didn’t have to do it, but this is why it’s all coming together like this. Here’s why I’m recommending this.

Here’s what I know. Here’s what I don’t know. I’m going to share maybe not a thousand misconceptions, but I’ll share something that you may have heard, something that I’m hearing more and more of. And to say, hey, I get it. I get the distrust. And I get that there’s trade-offs and risks with everything. But people want to hear, especially the skeptics within the system, they want to hear the trade-offs. They want to hear the risks, and they want to feel like they have some heightened level of ownership over their healthcare decision making. That it’s not just a matter of their doctor recommending one or, you know, say a test or a medication or some form of treatment, but that they are true partners and they own it in some way, for better or for worse.

They know what’s good, they know what’s bad, and they can help to make a little bit of that decision.

Melissa Gilkes-Smith: And really, all it comes down to is communication, communication from the clinician in that moment, in the room, in during that clinical encounter. Unfortunately, of course, you know, communication can be sometimes difficult when you want to spend so much time with the patient, but you don’t have, literally don’t have the time because there’s so many regulations around charting and everything that you have to document, everything that you have to follow, um, all of the MIPS documentation alone, you know, for practices. Um now, of course, with AI now in the picture, you know, clinicians do have an opportunity to spend a little bit more face-to-face relational time while AI is doing that documentation for you.

And so the AI finding, of course, is one that I want to spend a moment on because it connects to something critical for where healthcare is going. The report found that trust in clinicians could quickly erode if patients perceive that doctors are replacing real relationships and real clinical decision making with AI. Only 44% trust clinicians to use AI for imaging or lab interpretation. And for anyone in this space thinking about AI implementation, this is the data that you need to be taking seriously. And Ryan, what does this tell us?

Ryan Cohn: As we both know, AI is getting woven into the healthcare landscape in all these different ways. And it can absolutely help in terms of efficiency for charting. And if it allows for doctors to get more FaceTime with patients, to be able to listen, to be able to have a deeper conversation and not worry as much about the documentation part, then that is going to work very much in their favor. The challenge, though, as you mentioned, is that people very much are not ready for AI to get baked that much more into the decision-making process of their doctor. They have a trusted relationship, a bond between the patient and the doctor. And AI getting inserted between the two presents a really big potential issue for that trust.

We could see this last bastion of trust in our healthcare system, our doctors and that relationship. We could see it crumble if we let AI get too in too soon before people are ready. The technology may be there, but patients are not ready for AI to find its way that deep that quickly in the actual clinical process, especially if it could potentially take some of that judgment, decision making, and foresight away from our doctors.

Melissa Gilkes-Smith: There was a study that I read, and I had to pull it up about how some providers that are coming into the field now, because of the immediate access to information online, the use of AI, the critical thinking development of these providers, the nurses, you know, all of these clinicians has declined slightly because of the fact of just that immediate access to information. They can just look it up. However, you know, these are these are these are doctors, these are nurses, and sometimes these are emergency situations. And you’re not gonna have that moment to be like, uh, hold on, let me check, you know, my my my AI tool, um, yeah, that’s not gonna happen.

Ryan Cohn: What what I worry about though, and I know I’ve seen a lot of cheddar recently about Epic injecting Chat GPT directly into the health record system. If ChatGPT or any other AI tool becomes a helpful asset, well, the clinician is still looking at the chart, still making the decision. But when the effectiveness, when the accuracy of these AI tools and what they’re generating based on reviewing charts is closer to 99%, which is what I’m starting to see more and more, I do very much worry that the clinician may say, hey, look, I’ve got to see so many patients an hour. I’m in this emergency situation, I’m moving so quickly. I don’t want to, but I’m going to look more to that AI summary, to the AI recommendations.

And I’m not going to insert my critical thinking, my expert judgment that much more into the mix. We need to create that balance. We need AI to be a supplement to enhance our clinicians’ critical thinking skills. We need to make sure that it’s not replacing it. And that’s going to be more of that factor looking at operations, looking at the system overall, that we are still allowing for the time to be spent to review everything, allowing for great relationship building, for the trust, for listening between our patients and our clinicians, we cannot lose that.

Melissa Gilkes-Smith: Great. And at the end of the day, it’s still going to be the physician, the clinician that is signing off on that note. So regardless of what AI generated or what the clinician generated, it is the clinician’s responsibility for that note. And if you decide to trust that your AI tool has is accurate and you don’t need to check anything and you don’t need to use your critical thinking, that’s your signature. That’s still your responsibility.

Ryan Cohn: And I’ll say, let me add in here that also when you’re deploying AI within a practice and your clinicians are now not out there out front explaining it and why and how it’s fitting into the mix, then you’re spending trust that you can’t buy back. We need to be training our clinicians as those frontline medical leaders to be sharing not just that, hey, I’m here in this, you know, in this room with you, in this exam room with you. And by the way, I’m going to have my AI tool listen so I can focus here. But you have to go a little bit deeper and realize that a lot of patients may not trust the AI, and they need another 30 to 60 seconds of explanation of how it’s going to be used, what it has access to, the privacy, the security, and the accountability to one of the things, of course, that the clinicians aren’t going to, or it would be a difficult conversation to have is the cost aspect and is the I need to spend less time in these rooms because of the fact of the reimbursement rate.

Melissa Gilkes-Smith: So now I have to see more patients. And so now I’m depending on this AI tool to do more of my work so I can see more patients. And the report saw surfaces a cost finding that I think is essential for patient experiences professionals to understand because cost anxiety is not just a policy issue, it’s a patient experience issue. It’s what a patient is carrying when they walk through your front door. And 54% of Americans name healthcare affordability as their top concern. That is the only issue in the entire survey that commands a majority. Beyond affordability, American healthcare fears scatter across more than a dozen issues without consensus. Ryan, what does that fragmentation tell us?

Ryan Cohn: People are worried about affordability, not just in healthcare right now, but in groceries, in home ownership or rent. So we need to be careful with how that all works. We need to recognize that there are all of these opportunities to deal with cost anxiety directly. And because you have to really think about what does that anxiety look like on the front end? You’ve got a patient who’s calling to schedule an appointment. They’re not only asking when, but they’re asking also what’s it going to cost? Is my insurance going to cover this? They’re worried about that, but practices need to be ready to answer all of those questions clearly and succinctly and directly at the moment of that first call.

Melissa Gilkes-Smith: And the behavioral consequence of cost anxiety is something I want to name directly. 42% of Americans say costs led them to avoid or delay care, seek guidance from a non-medical provider or switch providers in the past year, and nearly two-thirds worry that healthcare costs could force serious financial sacrifices with no meaningful difference by ideology, gender, or income. This is nonpartisan. And from a patient experience lens, a patient who’s worried about what this visit is going to cost him is already behind before the clinical conversation even starts. So, what can practices and health systems actually do about that?

Ryan Cohn: They have to communicate about it. They have to be ready to answer those questions, and they have to be clear of how it all works together, that it’s not just a matter of the one interaction, but planning out steps deeper into the future. What does the entire care process, what’s our treatment plan look like? How much is it going to cost? And are there any adjustments that we’re going to have to make with that to make sure that you can actually afford it? That you’re not going to be worried about whether or not you can actually afford the treatment that you’re getting. Now, I’ll flag one thing that I found pretty interesting too. The population that is most worried about this far and away are the uninsured.

But the uninsured do not have a primary care physician who that they, you know, who they can turn to for this guidance. They worry about cost, they worry about access. They don’t believe that if they get hurt, if they get injured, that they will have anyone to turn to in that moment. They are going to see issues that keep getting exacerbated until they finally end up at the ER as that last ditch effort. And by then we know how it turns out.

Melissa Gilkes-Smith: And then once you hit the ER, the cost of the ER is just much greater than any primary care visit initially would have ever been. And then you get to the ER. Not all patients know that once they leave the ER, they can also turn to the financial counselor at the hospital because they are uninsured to reduce the cost. And, you know, you end up just those medical bills just end up piling up. And of course, there’s the communication aspect on the hospital side that says, hey, you know, on those medical bills, you know, make sure to put it right out there in front. If you need financial counseling, call this number, go to this website. Um, but then you have, you know, in the outpatient medical practices or even in the hospitals, these clinicians are now also becoming financial counselors.

Ryan Cohn: Yeah, I mean, that that’s really challenging, right? I mean, you go to medical school to learn about medicine, not to learn about finance. And that becomes a really big challenge. You’re counseling people, you’re guiding them through this complex process where initially clinicians might say, okay, well, I know how to play the system, I know how to play the game, I’m going to get them what they need, but I may have to have them jump through some hoops and everything. But now they’ve got to really focus on communicating how it all works together, what options exist, and then counseling those patients on those options, on what they can actually do, how they can take greater control over these next steps and look at it in a lot more of a holistic way, see how all the pieces are integrated together and figure out a solution that not just benefits the patient in terms of medical, clinical outcomes, but that they can also afford so they they don’t go bankrupt due to medical.

Melissa Gilkes-Smith: And let’s so talking about medical debt, let’s talk about the blame picture because I think it has direct implications for how healthcore organizations manage their reputation and their relationship with the communities they serve. Elected officials rank in the middle of the pack for shaping the cost narrative, but they absorb the second largest share of blame when costs rise just behind insurers. What does that tell us about how blame works in healthcare?

Ryan Cohn: It’s the crazy thing. So people don’t blame their healthcare leaders in all the same ways. They assign blame whether it’s for an inability to get an appointment. Uh they blame different people for that versus affordability. They’re blaming others there. And they’re all on different levels. Like you said, with politicians, for instance, politicians are getting outsized blame on the affordability of healthcare aspect, but people also don’t want their political leaders to have a greater seat at the table. They want them to be saying less in all of this, which absolutely runs counterintuitive to what we’re frequently seeing these days in Washington, for instance, where you’ve got members of Congress who are bringing up some of these healthcare leaders, whether it’s insurance CEOs, hospital CEOs, big pharma, they’re bringing them and saying, okay, you need to answer for all this when the American population actually wants their, wants their political leaders to answer more than just about anyone else.

Melissa Gilkes-Smith: So I think this is a great lead-in to spend some time on the experimental findings, because I think this is where the research gets most practically useful for the people in this audience. The influence index did not just ask opinion questions, it ran controlled experiments, the same guidance, different variables, and the results are instructive. Walk us through what you found.

Ryan Cohn: Sure. So we did this really interesting experiment where we told the respondents in our survey that public health investigators were tracking an emerging parasite. We gave it a fake name, uh, and we said that it can cause neurological symptoms such as dizziness, fatigue, even paralysis. Early reports suggest it spreads when microscopic eggs are picked up from everyday high-touch surfaces. Then we said that a common deworming medication, we gave a unique uh special name, uh, can prevent infection if taken once a month during peak transmission season. And then we asked different questions around okay, well, if the FDA recommends this, your doctor recommends it, different circumstances. And we did A B message testing to see what.

What messages, what leaders, what voices would have the most influence over guidance and decision making of whether or not to actually take this experimental medication? So, first of all, the experiment that we initially ran was around the messenger. And if you remember the 86% that we mentioned from the top of the show, where doctors are the most trusted voice in healthcare today, well, this is the experiment that tells you what trust actually is worth in terms of behavior. What we found is that word for word, that recommendation is identical across all the versions. But the one thing that changes is who said it, and a doctor moves 75% of people to take this medication. A PhD researcher, CDC, FDA all ranged from 62 to 64%.

So the doctor beats every institutional voice by 11 to 13 points. And what surprised me is that that also holds across politics. Liberals, 84% for the doctor, conservatives, 74%, moderates, 71%. There’s no version of America where the agency beats the doctor. So if your message is going out on institutional letterhead, you might be leaving double digits on the table. Put the clinician’s name and face on it because people trust their recommendation.

Melissa Gilkes-Smith: So do you think because of the fact that this experiment was done more recently, of course, years after, you know, COVID, after the pandemic, with everything that happened during the pandemic, all of the misinformation, and then, of course, everything that happened in the years after the pandemic that still relates to it, do you think that this has to do, you know, with the less trust in the CDC and the FDA and the researchers?

Ryan Cohn: I think that there’s definitely some of that lingering concern for sure. Uh, it’s frankly how we all see the healthcare system today. And I think some of the distrust that people place for the healthcare system, I mean, that is a combination of all the factors that’s led them, the interactions, the experiences that preceded the pandemic, but very much the pandemic shaped or reshaped how a lot of people across America see healthcare today.

Melissa Gilkes-Smith: So let’s talk about the prescription find uh prescription finding. You know, same drug, different description.

Ryan Cohn: So when we said this drug is effective, that got 62%. It’s been on the market for 50 plus years, got 56%. Well tolerated, 55%. So saying that it works beats saying that it’s safe and it beats saying that it’s been around a long time. And that one does surprise people because the instinct often in healthcare is to always lead with safety. And I get why, but the patient is asking a different question first. They’re asking whether this is going to help them. Answer that question first, then get to the safety. Look at patient education materials. And I bet most of them open with tolerability and history. Flip it, lead with the benefit.

Melissa Gilkes-Smith: And and we all hear the drug commercials. I think I heard one, it was, I think it was yesterday or day before. We were watching football, and one of these commercials came on, and you know, they talk about the effectiveness, but then they get over to the side effects. I was like, oh my gosh, I almost would rather just, you know, deal with what I have.

Ryan Cohn: Exactly. Exactly. That’s and that’s the challenge. But that right there, while a lot of people, I think, often will gloss over that last 15 seconds of the ad, it is really important because what we found time and time again in the survey is that you have to, you have to share not just the good, but the potential bad. You have to offer the side effects. You have to give patients the full picture of the good, the bad, and the ugly so they know exactly when they make that decision what they’re getting themselves into. And that will increase trust for sure.

Melissa Gilkes-Smith: And with that, of course, and there’s just so many drugs out there, but it’s also important for the provider, for that clinician to be knowledgeable and to understand what those side effects are. Um, I have a personal experience from years ago. I I um I had um insomnia, and I mean, I hadn’t slept for like four to five days. And so I went to my primary care doctor at the time, um, and she provided me some ambient. And I am a person that when I get a prescription, I am looking over all of the side effects, and then I’m paying attention to what I’m feeling after I take them. Well, I ended up with panic attacks the next day. And that is part of if you’re taking ambient. And so I thought it was an anomaly, but it happened like three days in a row.

And I’m as I’m driving home from a brand new job. And it also says, do not stop taking unless talking to your provider. Okay, go back to my provider. I have a conversation with her. I say, look, you know, I’m having these panic attacks the next day. And according to the side effects, it says this that that could be that’s one of the potential side effects. And then it also says, don’t stop taking it without talking to your provider. I’m here talking to you. Can I just stop taking this? I think I’ll be fine. I’ll, I’ll, I think I can sleep now. She looks at me and she goes, Well, let’s talk about the anxiety and the panic attacks. I think we need to schedule you for a mental health evaluation.

Wait a minute. Wait a minute. So completely just, you know, didn’t listen to what I was saying, wasn’t educated about the side effects, you know, wasn’t educated about the entire prescription that she prescribed me. Needless to say, I walked out and I just stopped taking the prescription and I didn’t go back. Um, but it’s this is just how important it is for a provider. If you’re prescribing something, you need to know about it, you need to be able to communicate about it, you need to be able to educate the patients about it. And when they ask you questions, you need to be able to answer them correctly.

Ryan Cohn: And we’re going to see more and more of that with the rise of AI when not just patients, but their caregivers, their family members, they’ve got more information at their fingertips. And I experienced this pretty recently when I had a family member who was in the ICU for a week, a hospital stay that was almost two weeks, and most of that time was spent on diagnosis for a really challenging condition she was dealing with. And so every day we’re meeting with the doctors and they’re recommending the next round of tests, they’re sharing results. And each day I’m going to her health record, I’m exporting the latest file, 150, 160 pages of information, and I’m dropping it into one of my favorite AI tools, and then every day updating it as the new records are coming out.

And I’m asking it questions to help me become a more educated healthcare consumer and advisor for my family member. And I was able to then go into these interactions with her doctors and say, Well, have you thought about this? Or what about that side effect of this? And and look, I mean, it made, I’m sure I don’t know if her clinicians, if her medical team liked it. I think some may have liked it, some may have not, because then suddenly I’m asking harder questions than they’re used to someone asking on the uh on the family or caregiver side of things. So they’ve got to be on their toes. Now, I did find it interesting, though, that the hospital would only update those medical records once a day, usually overnight.

And there was about a 24-hour delay on most of the results. So I was always operating from a position of delayed information. And I get it, they don’t want the family members, they don’t want patients having results in hand before the medical team can actually share and talk about it with them. But we need to recognize that healthcare consumers today and moving forward will have access to a lot more information. They’re either going to be more knowledgeable or they’re going to think they are used because of the tools that they have at their disposal. And we need to engage with them in slightly different ways and having slightly different conversations than we have in the past.

Melissa Gilkes-Smith: And having the information as a patient or as a patient’s family member is important. It’s useful. And of course, it depends on how we use that information. You know, if we are going to make a decision by ourselves, if we have information that we, you know, heard on a podcast, saw on social media, or just randomly Googled and make that decision ourselves, that can be very dangerous because our clinician has provided us with specific instructions and you know, prescriptions and such. However, if we use that information as you did, where it’s I’m educating myself on this symptom, on this condition, so that I can ask better questions to my clinician. And if I were a clinician, if I were a doctor and I had a patient that came to me and asked me the questions and didn’t make their own decisions, I would appreciate that and I would respect that.

Because they are also taking part and being a part of, you know, proactively being a part of their care, their treatment.

Ryan Cohn: Absolutely. And fortunately, I know that at least one of my family members’ doctors said that he did appreciate that. But I know that, hey, you know, for any of us who are in professional positions, there are some who like to be kept on their toes, who like to be pushed, who like, but but like you said earlier, when a clinician is constantly having to deal with the economics of what they have to do, and they may not have the time to spend pouring over diagnosis and charts and you know, asking the right questions, that does create conflicts. And so we do need to change some of those economics. We need to make sure that we’re prioritizing the right parts of these interactions and that we’re really elevating communication to the forefront of these medical experiences.

Melissa Gilkes-Smith: And I think we also need to somewhat touch on the responsibility of those social media, those creators, those podcasts, you know, creators. There needs to be a responsibility of some kind of disclaimer that says, I’m not a doctor. Ask your doctor. One thing I very much appreciate about Mel Robbins’ podcast is she does have that disclaimer that this is not medical advice. Um, I’ve and I listen to Mel Robbins religiously, love her podcasts. Um so I want to add also my own perspective here. Touch points is not trying to change the mind of the skeptical patient. It’s trying to equip the healthcare leaders, administrators, and patient experience professionals who are shaping the system, those patients interact with every day.

That’s a different job. And we’re doing it well. The impact shows up and how practices design their patient experience, not in public opinion polls. So I want to close with one most important section of this episode for our listeners. What do we actually do with this? Because the research is clarifying, but research without action is just a very well-documented problem. So, Ryan, the report closes with five moves for making the invisible hand visible. Walk us through those, and I want to connect each one back to the patient experience.

Ryan Cohn: So, first of all, position clinicians as thought leaders. That 32-point influence gap I mentioned earlier, is the whole argument there. Your most credible messenger has never been media trained. So start there, give them the mic, give them the microphone, give them a seat at the table, and trust that they can guide and persuade patients and our country overall toward a better healthcare future.

Melissa Gilkes-Smith: So positioning clinicians as thought leaders, that’s not just an advocacy strategy, that is provider communication training. And it’s making sure that the most trusted voice in healthcare feels empowered and equipped to lead the conversation with patients, not just to deliver the diagnosis, but of also, of course, that they have the time to do so.

Ryan Cohn: Absolutely. And with that, our number two is mobilizing frontline workers in healthcare as advocates. And I’ll attach a warning that 73% of healthcare professionals, like I said earlier, did take one of those trust-driven actions themselves. So they understand how the system works. They in many cases are skeptical. That’s why you have to co-create the message with them. You don’t just hand them a script or talking points, but you have a conversation and make sure that they feel comfortable sharing what they know, their inner workings, and that they can be true advocates for patients and for our healthcare system more broadly.

Melissa Gilkes-Smith: And that right there is the culture of care and action. Your frontline staff carry enormous credibility with patients when they embody accountability, compassion, empathy, and collaboration. They are doing the most powerful trust-building work in the organization.

Ryan Cohn: Absolutely.

Melissa Gilkes-Smith: So let’s go to number three.

Ryan Cohn: Yeah, number three, push back on misconceptions. 63% hit conflicting information in the past 30 days. So if you’re not filling that gap for your patients, somebody on the internet already has. And number four, test messages with skeptics. 48% of Americans say that evidence that they can check is what makes a healthcare message trustworthy. Among people who distrust the system, that climbs to 54%. And 29% of them specifically want to hear about the trade-offs and the risks. So it’s okay to pull back the curtain and to say, hey, here’s the good, here’s the bad, here are the side effects, let’s talk about the trade-offs, let’s talk about the risks. I may prescribe you that ambient, but know that this is what might happen as a result.

Let’s have that conversation on the front end. Let’s recognize that you may be skeptical, that you may have heard conflicting information, some true, some false, some twisted. Let’s address it all head on. And then let’s make sure that we are educating our clinicians and other healthcare voices on how to answer these questions and how to guide a conversation with potential skeptics.

Melissa Gilkes-Smith: And number three and number four is all about communication, of course. So, and you have that pre-visit communication, which starts with getting patients prepared for their appointment. What are they going to expect? What is going to happen? What are the, what is the cost transparency? What is the potential, you know, cost for that appointment, if that’s if that’s available to you to provide to them? Communication during the appointment, what is happening throughout the appointment, not it’s just the patient, well, this is happening to me. It is a communication during the entire appointment. And then that post-visit communication and follow-up. How is everything going? Have you started you? Have you picked up your prescription?

Have you gotten to go, you know, get those labs done? Following up with that patient, not just handing them their discharge paperwork and saying, okay, have a good day.

Ryan Cohn: You know, I’ll say I do a lot of crisis communications work with my clients. And the standard crisis instinct is to smooth over misconceptions and some of these issues that we’re talking about here. And you just reassure people, you keep it vague, but that performs worst with the exact audience that it was actually written for here. So instead, publish the evidence, name the trade-off, say what you don’t know yet. The skeptic is the one who’s out there checking. They want receipts, they want to know what you know and what you don’t know. And they’re the ones who you really need to reach today. It might be counterintuitive, but you have to work with them on their wavelength.

Melissa Gilkes-Smith: So the last one, building coalitions with trusted partners, local, beats federal, community level communication outperforms institutional messaging. What does that mean for how a practice engagement engages with the community it serves?

Ryan Cohn: So we talked a lot throughout this about clinicians and then some about hospitals and how they’re all trusted. But patient advocacy groups have a 27-point desired influence gap. And that was just second to your clinicians, to your doctors. And they also, patient advocacy groups also rank third on who people expect to tell the truth in a crisis. But only 2% name them as one of the most influential group or voice in healthcare today. So demand for them is exceeding supply by more than any other group except clinicians. So we need to think about how and who are talking about some of our critical healthcare issues out there today. Clinicians need a greater seat at the table. Patient advocacy groups are also very much trusted and need to be looked to, need to be worked with on a lot of a deeper level than they are today.

And recognizing that some of the bigger, most viewed as most powerful voices, for instance, your insurers out there, they really need to partner with some of the more trusted entities and talk about some of the really crucial issues that people are facing, like affordability and access head on, but also recognizing that there’s only so much they can say, that they really need to work with the clinicians, with patient advocacy groups, with some of these trusted entities to get the message out there, to correct misconceptions and myths, and to make sure that we’re having the conversations across our healthcare landscape that are responsive to what people actually want to talk about, the challenges that they’re experiencing, and recognize that that might be different from what some of our leaders out there today have been saying or would prefer to say.

Melissa Gilkes-Smith: So, Ryan, last question. For the healthcare leader who is listening right now, the practice administrator, the CMO, the patient experience director who walks away from this episode with the data in hand but is not sure where to start, what is one thing you want them to do this week?

Ryan Cohn: If a practice leader could do anything this week, they should go and put their clinician’s name and face on patient communication. Make sure that they are leading with the most trusted voice in the room, get it out there, lead with trust, and then address all the questions that they’re really hearing. Listen more, whether it’s on the phone from that initial appointment or in the room with the patient, listen and really start to address some of those challenges that people are having, maybe even in bulk. Communicate through the newsletter, through emails. Make sure that you’re hitting the right points, not just in the exam room, but out in the community. Be the advocate for healthcare locally and more broadly that we know that we have here, but just are not tapping nearly as much as we should be today.

The good news is that the most credible voice in American healthcare already works in our communities for our practice leaders. We just haven’t given them the megaphone and asked them to speak up.

Melissa Gilkes-Smith: Ryan, what this research makes clear is something I’ve believed for a long time, but now have the data to say it directly. Trust is not a sentiment metric. It’s not something you measure in a satisfaction survey and report on quarterly. It is the infrastructure that every touch point in the patient experience rests on. When it erodes, every other investment in patient experience is built on shifting ground. And the finding that should keep every healthcare leader up at night is this patients trust their doctor. They do not trust the system their doctor works inside. That gap is costing patients in delayed care, in skipped medications, in abandoned follow-up. And it’s also costing healthcare organizations in ways they may not yet be measuring.

The good news is that the research also tells us what works. The messenger matters, the local voice matters, transparency matters. The clinical relationship, when it is built with genuine accountability and compassion, is still the most powerful trust-building tool in healthcare. Our job, all of our jobs in this field, is to protect and amplify it. Your challenge this week, look at the last three pieces of communication your practice sent to patients. Ask yourself, does this communication make the invisible hand visible? Does it acknowledge what patients are actually worried about? And does it use the voice they trust most or the institutional voice they trust least? Ryan, thank you for building this research and bringing it to touch points today.

I think this is a conversation our field needs to be having. Links to the 2026 SACS Health Influence Index and Ryan’s contact information are in the show notes. Every interaction is a moment that matters. I’m Melissa Jilk Smith, and this is Touch Points. If this conversation moved you, subscribe wherever you listen and connect with me on LinkedIn. See you at the next touchpoint.