This report compares the views of people with Medicaid and of primary care doctors on how to build mutual trust. Based on representative surveys of both populations, main findings include:

Finding 1: Primary care doctors and people with Medicaid agree that trust should be mutual. Both feel equally responsible for building it and both feel that it takes time to develop. Doctors overwhelmingly trust patients with Medicaid unless that trust is broken. But more people with Medicaid express wariness, with nearly 4 in 10 saying doctors need to earn their trust.

Finding 2: Primary care doctors and people with Medicaid agree that in order for doctors to gain patients’ trust, good listening and communication are top priorities. But the two groups have different priorities regarding other ways doctors can gain patients’ trust. People with Medicaid prioritize doctors following basic safety protocols, while doctors think it is more important to consider their patients’ finances and lifestyles. Few people with Medicaid say that a doctor’s race or gender affects their trust.

Finding 3: Nearly 4 in 10 people with Medicaid say they have been treated by a primary care doctor whom they did not trust. Most people who have had those negative experiences say that as a result, they have behaved in ways that could negatively affect their health, such as stopping medications or delaying care. More of those who have been treated by a doctor they did not trust also say they have behaved in ways that could damage doctors’ trust in them.

Finding 4: Primary care doctors largely feel that patients with Medicaid are just as trustworthy as patients with other types of insurance. But when patients with Medicaid are actively engaged in their care, such as by participating in decisions or voicing their health goals, primary care doctors trust them more. These doctors are less trusting, however, when patients with Medicaid leave out information, exaggerate symptoms or insist on specific treatments.

Recommendations for Building Mutual Trust in Primary Care

1. By demonstrating that they take safety seriously, doctors can help build trust with patients.
2. Increasing patient activation and engagement may increase doctors’ trust in patients.
3. Creating time and space in primary care practices for mutual communication can build reciprocal trust.
4. Doctors can build trust by finding ways to discuss social determinants of health without alienating patients.
5. Developing the evidence base for how and why doctors should build trust in patients can help move health care away from paternalism and toward centering patients.