A history of medical mistrust and its echoes today

This two-part episode of the CMAJ Podcast explores the roots and repercussions of medical mistrust. It begins with a historical lens, revealing echoes of today’s strained relationships between patients and the medical system, then narrows the scope to focus on a pressing clinical example.

In part one, Dr. Kenneth Pinnow, a historian of Soviet medicine at Allegheny College and author of the article in CMAJ entitled Soviet medicine and the problem of public trust: 1921–1929, walks through the fraught relationship between physicians and the public in the early Soviet era. He explains how underfunding, class tensions, and unrealistic expectations resulted in widespread hostility toward physicians and fractured trust that proved difficult to repair.

Part two narrows in on vaccine hesitancy, a timely example of medical distrust made more urgent by recent measles outbreaks. Dr. Noni MacDonald, a pediatric infectious disease specialist at Dalhousie University and former member of the WHO’s Strategic Advisory Group of Experts on Immunization, describes how trust is built—or lost—between patients and clinicians. She outlines practical strategies for frontline providers, from using presumptive language to engaging in motivational interviewing, and offers tips for addressing vaccine concerns efficiently, even in short appointments. 

For physicians, this episode is a reminder that trust must be earned repeatedly—through expertise, empathy, and systems that allow both to be seen.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

Transcript

Dr. Mojola Omole

I'm Mojola Omole

Dr. Blair Bigham

I'm Blair Bigham. This is the CMAJ podcast.

Dr. Mojola Omole

So today we're looking at a really compelling article in the humanities section of CMAJ. It was looking at public distrust of the healthcare system in the Soviet era and the parallels that we have today in our society with what seems to be, I don't know how you feel Blair, almost like a tsunami level mistrust since the pandemic in healthcare.

Dr. Blair Bigham

Absolutely. I was fascinated to go back a hundred years and read the story of... 

Dr. Mojola Omole

Sorry, weren't you alive around then?

Dr. Blair Bigham

Oh no, we must be talking about our producer, but back in the 1920s, shortly after the Russian revolution, we actually see this horrible disintegration of trust between not only physicians and government leaders, but also physicians and members of the public, like physicians were being murdered and jailed. Like it was horrible.

Dr. Mojola Omole

Yeah. And it was, as I was reading the article, I'm just like, you know what? Just, I don't know if there's much that has changed.

Like there is still, it's like this large chasm between physicians and those who are high earners and, you know, working poor, working class people who are trying to make ends meet and how that plays out when it comes to healthcare and getting their healthcare system and trusting those who deliver healthcare to them.

Dr. Blair Bigham

So today we're speaking to two guests. First, a historian who is an expert in not only the history of medicine, but also the history of the Soviet Union and misinformation. And then instead of looking at the broad issue of distrust in medicine, we're going to zero in on a specific case study, the phenomenon of vaccine hesitancy, a critical issue now, as we see these measles outbreaks in Canada and all around the world.

So we're going to speak to an expert about how we can build trust specifically around vaccines, one patient at a time.

Dr. Mojola Omole

Dr. Kenneth Pinnow lives in Pennsylvania, where he's a professor of history of medicine at Allegheny College with a specialty in Russia and the former Soviet Union. He's the author of a recent article on the CMAJ exploring how trust in the medical profession evolved in that period. And then unfortunately devolved in the earliest Soviet era.

Ken, thank you so much for joining us today.

Dr. Kenneth Pinnow

It's great to be here. Thanks for having me.

Dr. Mojola Omole

So let's just talk a little bit about that early Soviet period. What was the relationship between physicians and the public like then?

Dr. Kenneth Pinnow

Well, the relationship between doctors and the public was rather fraught in the early Soviet period. So we're talking about the 1920s, so essentially the first decade after the revolution. And it's fraught for several reasons.

First, many physicians opposed the Bolshevik revolution. So they came into the situation with a strike against them politically in terms of the regime. And then they're also having a fraught relationship with the public in the sense that many of them had been trained before 1917, were from a class background that might have varied from the new bosses, as they called it.

So we're talking about the working classes, the laboring classes, the peasantry in whose name the revolution had been made. So there are some class tensions between doctors and the public. And then as I talk about in my article, there's tensions between doctors and the public in terms of perceptions about care, the type of care that people are getting or in some cases feel that they're not getting.

Dr. Blair Bigham

But there's something about that Russian revolution moment and the physicians being on the wrong side of it that set them up, maybe to then face all this public abuse in the new system?

Dr. Kenneth Pinnow

Well, it sets them up in the sense that the regime is somewhat distrustful of them and will periodically use their politics against them.

Dr. Blair Bigham

But didn't it also place expectations on them that were, just like, not realistic?

Dr. Kenneth Pinnow

Yes. So I guess the other thing I would emphasize is that when the revolution happens in October of 1917, rather quickly, the Soviet regime starts talking about a new type of health care system. So they're talking about universal health care, what we might call health care for all.

Soviet medicine is driven by the idea of what was called social medicine or social hygiene at the time. Very strong emphasis on prevention. So they're pushing doctors to move away just from therapy and therapeutics, but also to prevention.

And this does cause a lot of tensions.

Dr. Mojola Omole

So when you said tension, did it cause tension with the physicians or with the public?

Dr. Kenneth Pinnow

Well, that would be with some of the physicians who they claim are slow to adopt this preventative ethos. We're talking about retraining in some cases or changing education. So some of the more, some of the physicians who are more on the side of the revolution are accusing some of their colleagues of failing to adopt this new mindset, which emphasizes, as I mentioned, prevention.

There's a strong social ethos there. And I guess one other thing I'd emphasize about Soviet medicine, Soviet medicine ascribed to what we now today call the social determinants of health. They are speaking about health as not just a biological phenomenon, but also the product of a person's economic circumstances, of home life, of psychology.

And they adopt what I would call a holistic approach to health. And they're trying to push doctors to embrace this rather holistic approach. And that does cause some tensions between the regime and some doctors who maybe are less inclined to accept that idea of health care and the doctor's role.

Dr. Mojola Omole

At the same time, though, the government were also trying to, they were encouraging people to trust these, to trust doctors because they were agents of modern medicine, but also they labeled them as part of the old elite. And so there was suspicion there. Can you just walk us through how that tension played out?

Dr. Kenneth Pinnow

Yeah, great question. So the, I guess another thing I'd want to back up and just say about what's happening here, we also see maybe a generational divide that we have some physicians trained before the revolution, maybe of a particular political persuasion, and then gradually we're seeing the rise of doctors that are being trained after the revolution. So the new regime is trying to educate new types of doctors that would better fit their ideological values and their visions for society.

So, so we have this tension between, I'd say the old and the new, or a coexistence of all the new values, all the new types of practices and beliefs. And I think that's part of what's coming out in the conflicts with members of the public. In terms of the regime, the regime is very much speaking in class terms and will periodically ramp up the class warfare.

So, so, we see it at different points in the 1920s and then into the 1930s that the regime is pushing modern medicine. They see science as the solution to the future. They want people to believe in scientific medicine and get them from going to the local healer or the, or in their, or the local midwife and instead go to these doctors.

But then at the same time, they have a countervailing message. You can't trust these people because often of their backgrounds in terms of their politics and their class. So that, that's a tension there that I find really fascinating in terms of how the regime is both promoting and also undermining at the same time.

Dr. Blair Bigham

And this actually led to quite remarkable hostility. In your essay, you talk about both the public actually being violent towards physicians, a case of murder, and in, on the other side with the government coming at them, legal proceedings, ending up in jail. Just how hostile was it for doctors at that time?

Dr. Kenneth Pinnow

Well, we have to be a little cautious because most of our records, the records that I've been able to see so far, come from the standpoint of physicians. The voice that I don't have, which I would love to hear, to have more of, is the voice of the patients and those who are committing these acts. But the doctors in the mid and late 1920s are talking almost constantly at different meetings and venues about the perceived rise and hostility towards them.

And this could be in terms of verbal assaults, physical assaults. We have several high profile murders that are brought up all the time in conversations, and they're complaining that, that this is affecting their ability to be doctors, that they go into the clinic and they go into their, to meet what their, their patients worry that if something goes wrong or they're misinterpreted, it could result in some sort of violent reaction.

Dr. Mojola Omole

Was there any insight into what they thought? Because you said you don't have, necessarily, first hand accounts in terms from the patients. Was there any insight into what was the, what influenced this heavy distress aside from the government?

Dr. Kenneth Pinnow

Well, there are multiple aspects, some of it in a more positive way. They, I think they see the patients are now exercising their power that's been given them by the new regime. We see patients talking in terms of rights and having high expectations about how they should be treated.

So when these expectations are not met, it's then interpreted either as the doctor doesn't care, the doctor's incompetent, or maybe even the doctor's malevolent and is trying to do something negative towards me. The biggest or the widest explanation that they have is historical and cultural. They talk in terms that a lot of the patients coming to see them don't, from their perspective, properly understand medicine and what doctors do and have to go through.

They don't understand the many responsibilities that doctors have on them, which may limit their ability to spend time with them or as much time as they would like. And one thing that's really fascinating about the Soviet period is they argue that people have an over heightened sense of medicine's power, that they feel that many patients come in thinking that medicine can solve all problems or can do more than it can. And then if they get a bad diagnosis or things don't work out, again, they attribute that to the doctor.

The doctor must have done something wrong or maybe done something on purpose to harm them or to not heal them as they expected.

Dr. Blair Bigham

I mean, I guess they had just introduced this idea of universal health care. And you write about how the physicians were maybe under-resourced to help that be fully realized with very short appointment times, very rushed. These are all things that I can relate to in present day.

But tell us a little bit more about how the actual system, the pressures on the system was making it really difficult to build trust between patients and physicians.

Dr. Kenneth Pinnow

Yeah. So that brings up the question, I would say, of structural factors. And the regime is promising quite a bit in terms of care, especially, again, for the labouring classes.

And what we see is a pattern, a broad pattern of underfunding. The Soviet regime in the 1920s is in deep economic crisis, which limits its ability to fulfill its promises in terms of resources. And this is particularly bad in the countryside.

They are training doctors, but getting doctors to go out to the rural areas is very difficult. So we see patterns of the rural areas lacking doctors or maybe lacking well-qualified doctors. There is a lack of medicines and other types of equipment which adds to it.

So the absence of these types of resources is causing stress. The other thing is that doctors are often, they have expectations on them in terms of how many patients they have to see every day. And that brings up what becomes known as there's a kind of factory-like quality to Soviet medicine that they must see six an hour, which means 10 minutes a patient.

And there's a lot of griping on both sides about that. Doctors are unhappy about that. The patient is.

So that kind of sense of expectation.

Dr. Blair Bigham

I'm starting to see a simile here with maybe modern day medicine as well. And so I want to take a step back and look at efforts to build trust. And in your essay, you write something that really struck me.

You say, the trust given to physicians derives from a mix of moral authority and expertise. It reflects the social norms and expectations that are shaped by tradition, experience, routines and other factors that affect reputations and notions of risk. So if we're looking at both having a moral authority and an expertise, tell me a little bit about the strategies that the Soviets pursued to try to fix this division, to try to bring trust back to medicine.

Dr. Kenneth Pinnow

Well, if we talk about expertise, there is a lot of conversation about improving the training of physicians. So the medical community does recognize it has a role to play in this. They talk about the fact that, we'll call them so-called bad apples, are bad for everybody.

If there are doctors who are incompetent or poorly trained or brusque with their patients, that looks badly on everybody. So there's the emphasis on just improving the quality of the physician that is going out. But they put a lot of effort and it goes back to the ethos of Soviet medicine on education and building a culture.

It's not necessarily focused, they're not talking necessarily about trust, but building relationships. So Soviet doctors, as part of this system, were seen as social workers.

So they're supposed to not to stay in the clinic, but get out into the field, get to know their patients, go to their patients' homes, go to their patients' places of work to try to improve their living conditions there. They're told to have talks and lectures in the community to, again, educate the public about what can or cannot medicine do or how many hours a day am I working on this or that? And that's why I can't respond to you.

So there's that notion of building up the public knowledge, but also, I think, building relationships there at the same time. And so that's where I think it's about both the expertise that they themselves are fulfilling the expectations in terms of knowledge and capabilities, but also building up that trust through personal relationships and through cultural development.

Dr. Blair Bigham

As a trust researcher, I think a lot about how physicians in particular, but other people in positions of authority can help build trust. And so I was particularly struck by one of the concluding sentences in your essay that said, the case of Soviet doctors is a reminder for us today that earning and keeping trust is a continuous process of negotiation. And here's the interesting part.

That is only partly controlled by the medical community. What do you mean by that?

Dr. Kenneth Pinnow

Well, there I was trying to get that I think the Soviet case clearly shows and the Soviet medical community is maybe a particular case because of their relative lack of autonomy and power in that system, especially in the 1920s. But it clearly shows that here we have the case of the government or the regime playing a major role in shaping public opinion and the relative weakness of the medical profession in the Soviet Union made it hard for them to control the dialogue around trust.

And so I guess it to me in writing this piece and thinking about it, just reaffirm that that we are part of systems. We are part of larger institutions. We rely on others to keep trust in those institutions.

It can't just be us. But then on the other hand, it is up to us on an individual level in terms of the kind of relationships that we build with people, using opportunities to meet with people where they're at and try to build that trust. So going back to your question, I think it's a mix of advocacy on a broad level, whether it's on the part of a medical association, but also on the part of politicians.

They have to kind of have the back of the medical community. And then it's also on the part of, I imagine, individual doctors themselves. And I think there's a bit of that going on in the Soviet case, which got me thinking about that.

Dr. Mojola Omole

It's really great. Thank you. 

Dr. Blair Bigham

Fascinating. Yeah. 

Dr. Mojola Omole

Thank you so much for joining us today.

Dr. Kenneth Pinnow

It was my pleasure. Thank you for having me.

Dr. Mojola Omole

Dr. Kenneth Buneau is a professor of history of medicine at Allegheny College. He joined us today from Pennsylvania.

Dr. Blair Bigham

You know, Jola, it's not difficult to hear echoes of the Soviet experience from 100 years ago in the health care system that you and I work in today. Modern medicine is facing its own trust crisis. And one of the very tangible signs of that distrust is the resurgence of measles outbreaks, not only in the U.S., but here in Canada as well. And sinking vaccination rates are a striking case study on how trust between patients and the biomedical community can be lost. But for me, the question is, can that trust be reestablished? And to help answer that question, we're welcoming Dr. Noni MacDonald to the podcast. Noni is a pediatric infectious disease specialist at Dalhousie University in Nova Scotia and a former member of the World Health Organization's Strategic Advisory Group of Experts on Immunization. Noni, thank you so much for joining us. 

Dr. Noni MacDonald

My pleasure.

Dr. Blair Bigham

When we think about vaccine hesitancy in the modern era as a case study, what do we know about how trust is built or lost between patients and their health care providers?

Dr. Noni MacDonald

So let me back up six steps, Blair, on that. No, number one is the most influential person in study after study after study of whether you will accept a vaccine or not is what your health care provider tells you. 

Dr. Blair Bigham

Really?

Dr. Noni MacDonald

Yes. Study after study. I don't care what country you're in, Portugal, Latin America, Canada, the U.S. Study after study. But what you've raised here with this Soviet Union article and what you've looked at in the measles outbreak is joining two pieces together. If you don't come to your health care worker, they don't have a chance to tell you what you need to do.

Dr. Blair Bigham

OK, now with the information ecosystem, you can get that…

Dr. Noni MacDonald

Well, you can think you're getting all of that from what you can. You can become your own physician director for your health care worker. 

So going back to say, what is it that people who do work with health care professionals and that patients, what is it that the patient's looking for? They're looking for two elements. They're looking for your content expertise.

Like, do you actually know what you're talking about or what you're saying is rubbish? And then they're looking for your compassion. So do you really care about me or you're a little techno robot that really doesn't care about me that's just going, nya, nya, nya, nya, do this. OK. And you don't really get me.

OK. And you have to have both of those components to get trust. And I think two sides of this is what's happening.

Dr. Blair Bigham

So tell me, it sounds like that's difficult to balance because to be authoritative in my expertise, I feel like I have to put on a tough voice. But then you're also saying, oh, and also like I'm here for you. I'm altruistic. I'm doing this for the right reasons. How is a physician to balance that?

Dr. Noni MacDonald

Well, one of the things we know is if I say to you, Blair, it's time for you to get your measles shot, which it isn't. You should have had it already long ago. OK, but that is very differently heard than I say, “What would you like to do about your measles shot?” OK. And the participatory one, the latter one that I gave you, that doesn't work.

The presumptive one, it's time for you to get it. So let's talk about it, is much more ,you're likely going to make a decision about getting immunized. So it's how I say it to you.

Dr. Blair Bigham

Oh that’s almost counter-intuitive.Because I would have thought, I'm not pushing this on you. What do you want to do is maybe what I might have thought would work.

Dr. Noni MacDonald

Well, and actually, I don't remember the exact numbers, but it was a study from OPAL in 2013 when they actually did a random study to show that. And if you did the participatory, 14 percent of them chose to get their kid immunized. If you, if you did the presumptive, it was over 80 percent.

Dr. Blair Bigham

So coming in with a I know that immunization is recommended, is the way to go.

Dr. Noni MacDonald

That's right, because it's me saying I've looked at the evidence and this is what I think you need to do. Now, it doesn't mean you're going to go and do it right away. But what it means is now I've opened the door.

We're really going to talk about this. It's clear this is what I think you need to do. Now, what are your worries?

What are your concerns? What do you think about immunization? And then you go through what would be called motivational interviewing.

Dr. Blair Bigham

And so if a patient is hesitant, what can a clinician say or do in that motivational interview? Give me some hard examples here.

Dr. Noni MacDonald

OK, so it's really fairly straightforward and you can learn to do this. There's good models that are online from WHO and from other organizations on how to do motivational interviewing. And I want us to be very proud as Canadians, because some of that research came from Canada.

OK, and we're considered one of the leaders in that particular area. All right. So let me tell you how to do this.

So it would be,  “Blair, tell me what you know about the measles vaccine. Do you have concerns?” And I shut up and listen.

Dr. Blair Bigham

Got it.

Dr. Noni MacDonald

OK, and then when you've done your talking, I come back and say, “this is what I heard. This appears to be what's your concern. Can I give you some information and evidence about that?”

And if you nod like you just did, then I would do the evidence for you. And then I would ask you, “what do you understand from what I've said?” OK.

And then we would say, “how do you feel about going ahead to be immunized?” And then I would summarize what we've said.

Dr. Blair Bigham

So my initial reaction to this is, first of all, that I'm not here to train my patients to be epidemiologists. And second, my clinic is already running behind because of this conversation. Does that resonate with you?

Like, this seems very frustrating.

Dr. Noni MacDonald

Yeah, it is very frustrating. But I think there's a couple of things that you've said that are important. If you have a patient that has real difficulties with immunization, you may want to either refer them on to an expert clinic, a place where people and public health often has these in our major urban centers.

It's a little harder if you live rurally. But sometimes you can do virtual clinics rurally with an expert that you could refer them to. And or you could try to book them in for a longer consultation on that specific topic when you know you're going to have more time.

If you've got a waiting room full of people, you're not going to be able to spend all that time. But I'm just going to come back to where I began with motivational interviewing. One of the studies we did here, and we were one of the centers at the IWK, along with several other ones across Canada, five minutes, Blair, five minutes using the motivational interviewing technique for mothers when their babies had been born within the previous 48 hours, changed what the mother's decisions were about vaccines in a very positive way at two, four, six months.

And so you don't have to have a ton of time to do this because most of them just listening to what their concerns are and then saying, “can I tell you what some of the science says? And this is what I heard you understand from that,” gets you where you need to go.

Dr. Blair Bigham

So one of the things this makes me think about is how easy it is to get information, whether it's right or wrong, online. And so it's so convenient to just do it yourself. Right.

Like I tried to fix my own refrigerator, not because I don't trust refrigerator repairmen, but because I just didn't want to bother having to book them and pay them and blah, blah, blah.

Dr. Mojola Omole

Like you, as in Blair Bigham. 

Dr. Blair Bigham

And I did it successfully.

Dr. Mojola Omole

Let's see if it works in a few.

Dr. Blair Bigham

So two things here. These system level issues like my appointments are short, my wait times are long. You've got to come to a doctor's office because it's not easy to book online or whatever.

How much of that are we actually, you know, by our own processes or traditional barriers to coming to us? How much are we undermining trust in the system, in ourselves? Because people don't have to come to us anymore the way they used to.

They can go and find all sorts of information at their fingertips.

Dr. Noni MacDonald

We need to be teaching what science is and isn't when we're educating kids. And I'm amazed at how much kids really understand if you just give them the information and they have to weigh it up and they have to see what the logic is. If you look at Finland, they score the highest on media literacy year after year, but they've been doing this for about 15 years.

And what's fascinating about Finland is they're having different conversations than you're finding in the United States, for example, because they're so literate. They know when this is rubbish. Now, maybe we need some help sometimes, because I don't know.

Like if it was about mechanics, I don't know about mechanics of my car. So I wouldn't necessarily be able to know if this person was telling me rubbish or not. All right.

But I know enough to know that I need to talk to somebody who could sort that out for me.

Dr. Blair Bigham

I could talk your ears off about the Finnish experience. But what I want to do is to close, I just want your expert advice here for clinicians on the front line, busy, overwhelmed, frustrated. One pro tip and one pitfall to avoid when speaking with people who aren't ready to get vaccinated.

Dr. Noni MacDonald

Presumptive versus participatory that we explained before. And second one is listen to what the concern is. Don't just dismiss them. Because a lot of times listening and being respectful and then explaining why you come from where you come from and what the evidence is will move them over. Some of them, you just have to agree to disagree on this.

But don't give up on them. Bring them back again. Six months later, when they've come in with their sore knee, you can say, and what about your shingles vaccine that you need?

Or what about your pneumococcal vaccine? You just have to keep going, because part of what we do as physicians is try to, for every patient, give them the best care we can. And that's based on what the evidence is.

Dr. Blair Bigham

Noni, thank you so much for your time. This has been an awesome conversation.

Dr. Noni MacDonald

You're welcome.

Dr. Blair Bigham

Dr. Noni McDonald is a pediatric infectious disease specialist at Dalhousie University. So, Jola, I don't know which one of us are going to have more thoughts on this. Do you want to go first?

Dr. Mojola Omole

What really stood out for me is that we are going through in North America and probably across a lot of democracies, this wave of populism. And the basis of populism is pitting the elite against the ordinary folks.

Dr. Blair Bigham

And whether we like it or not, doctors are not. We are not the proletariat. We are elite.

We make a lot of money. We have a lot of respect, presumably.

Dr. Mojola Omole

And, but what that creates, though, when we have that political movement of populism is that it actually erodes trust in experts. So we are no longer experts. And similar to what was purposely done during the Soviet era, maybe I don't think it's also being done now on purpose.

But that is what it is creating is that now we have populations who are our public doesn't believe in us because we're out of touch. We’re elite.

Dr. Blair Bigham

But in the Soviet era, you also now have this condition where you don't have to rely on your physician. It's not convenient to see your physician. You might not even have a physician you're attached to.

And so you can go on your phone, you can go on your laptop and you can try to find your own answers. And the way people are presenting those alternative pathways to information, it seems to be striking a chord. It resonates with people.

Dr. Mojola Omole

Well, because I also think that part of it is if you don't have a family doctor, you don't have access to health care, but there's this really charismatic person who's telling you that if you juice, you'll get rid of your cancer. 

Dr. Blair Bigham

The fake expert. 

Well, it seems accessible to you or that, you know, the problem, like if, you know, if you have measles, you know, it's good for your immune system is that, well, there's nobody else in that void that's filling it.

And A, I think they are charismatic. And two, there is something that's part of populism, that's part of us, that wants to return to a simpler time. And it does seem simpler, quote-unquote, that I can eat my way well.

That, you know, all I have to do is do X, Y, and Z and drink this, this, and that, and I will never have a disease.

Dr. Blair Bigham

The world is certainly seeming more complex, right? Like what social media and misinformation does is it offers us a simpler world, like you were saying, Jola. And I just wonder how we, as physicians, need to sort of accelerate our own comfort in changing the way we do business.

Dr. Mojola Omole

We need to find, my answer is like we need to be in those spaces. We, like I've given talks about this, is that we need to be in, we need to meet, our public doesn't come, our patients don't necessarily always come to us anymore.

We need to go to them.

Dr. Blair Bigham

Noni was saying it takes time. You have to have these conversations at the right pace. People have to think that you are compassionate.

I think that was one of her criteria for trust. You have to be there for them. And if you seem rushed, well, forget compassion.

Maybe you have expertise, but you don't have that other half of the trust equation.

Dr. Mojola Omole

And it's, and I think that this is not, it's not a failure of physicians. It's not a failure of our primary care. It's a failure of the system, a system that is built that will never allow family physicians to actually have the time with a patient that's in front of you and develop that trust and have that relationship.

Dr. Blair Bigham

I don't think patients want to spend 30 minutes with me because they can get it on a 30-second TikTok video.

Dr. Mojola Omole

Sorry, have you seen me? I know this is a podcast, but they want to spend 30 minutes with me. Maybe not you.

Dr. Blair Bigham

They don't even want to spend 10 seconds with me in an emergency department.

Dr. Mojola Omole

But they actually do, like they do want to spend time. But we do not have a healthcare system now when it comes to family medicine that allows physicians to practice that way. So I do think that it's also a failure of the system.

We can't always be, okay, well, we need to do this. We need to do this. No, what does our government have to do for us?

Dr. Blair Bigham

That's it for this episode of the CMAJ Podcast. If you like what you heard, please like and share wherever you download your audio or just tell your friends when you see them around the hospital. The CMAJ Podcast is produced by PodCraft Productions.

I'm Blair Bigham.

Dr. Mojola Omole

I'm Mojola Omole. Until next time, be well.