Physician-Patient Relationship

Trust sits at the centre of the physician-patient relationship. It rests on the belief that a physician is competent, truthful, and committed to the patient’s welfare. Moral standing, in contrast, reflects broader public judgements on physicians’ moral character. In practice, the durability of the physician-patient relationship heavily depends on both interpersonal trust and broader perceptions of physicians’ integrity. These expectations became especially salient during the COVID-19 pandemic, when scrutiny of medical professionals and institutions intensified across the United States and the world.

Institutions and Public Confidence

Trust in physicians is heavily influenced by broader institutional frameworks, including hospitals and public health agencies. During the COVID-19 pandemic, conflicting guidelines and ever-changing protocols created uncertainty for patients, physicians, and institutions. To quantify these changes, the Kaiser Family Foundation conducted an online and telephone-based survey of 1,024 American adults from June 2023 through January 2025. This study found that the percentage of people who trusted state and local health officials “a great deal” or “a fair amount” dropped from 64% to 54% during this time. The same measures of trust also dropped from 93% to 85% concerning their own physicians. A 2023 review of 725 studies in the Milbank Quarterly likewise found that institutional credibility shapes both trust in physicians and perceptions of their moral standing.

Pre-Pandemic: Trust in Physicians

Since 1976, Gallup has annually conducted public opinion surveys across the United States on the trustworthiness of a multitude of professions. In these polls, respondents rated professions according to how honestly and ethically they were perceived to behave. Respondents were asked to rate each profession on a five-point scale ranging from “very high” to “very low”. From 2000 to 2019, at least 60% of respondents rated physicians “very high/high,” with an average of 63%. Since 1994, physicians have been a profession regarded by the majority as positive, signifying that at least 50% of respondents rated them “very high/high.” These pre-pandemic trust levels created a stable baseline in which patients generally deferred to physicians’ judgement.

Pre-Pandemic: Moral Standing of Physicians

A 2019 Social Science & Medicine analysis of 681 Americans found that they rated physicians highly on intellectual traits such as self-control and memory. The same analysis also found that physicians were rated as more moral than non-physician professionals. A 2015 study similarly found that patients with greater care needs placed a higher value on physicians who provided emotional support. Prior to the pandemic, physicians were judged not only by clinical competence, but also by whether they appeared emotionally responsive when care felt most urgent.

Pandemic Era: Trust in Physicians

The COVID-19 pandemic led to heightened reliance on medical expertise as patients sought guidance amid uncertainty about viral transmission and mortality risks. Survey data published in JAMA Network Open analysed responses from 443,455 U.S. adults between April 2020 and January 2024. In April 2020, 71.5% of respondents reported having “a lot” of trust in physicians. Gallup public surveys showed an increase in public trust in physicians at the beginning of the pandemic. In 2020, the percentage of respondents rating physicians “very high/high” was 77%. This was the highest rating since Gallop started this survey in 1976. It marked a sharp increase from 2019, when 65% of respondents rated physicians “very high/high.”

Pandemic Era: Moral Standing of Physicians

Moral expectations rose during the pandemic as physicians were relied upon to deliver accurate guidance amid shifting scientific evidence. Resource shortages and evolving clinical guidance forced physicians into ethical dilemmas. Their decisions were often publicly scrutinised, particularly when shortages of hospital beds and ventilators forced physicians to consider patients’ likelihood of recovery. As triage considerations became more widely discussed, physicians’ actions were increasingly interpreted through a moral lens rather than as solely clinical judgements. Consequently, the pandemic heightened scrutiny of physicians’ ethical responsibilities and intensified public evaluation of the profession’s moral integrity.

Post-Pandemic: Trust in Physicians

Trust in physicians quickly declined after the initial surge during the pandemic. By 2024, JAMA Network Open reported that the number of respondents expressing “a lot” of trust in physicians and hospitals had fallen to 40.1%, down from 71.5% in April 2020. A similar decline in trust was noted in the Gallup public survey for the years after the pandemic. 2021 and 2022 showed consecutive decreases in “very high/high” public ratings, dropping from 77% in December 2020 to 67% and 62%, respectively. The decline continued through 2023 (56%) and 2024 (53%), before rising slightly to 57% in 2025. Gallup’s 2023-2025 figures were the lowest for physicians since 1999, when 58% of respondents rated physicians as “very high/high.” 

Post-Pandemic: Moral Standing of Physicians

The decline in public trust following the COVID-19 pandemic raised concerns about the perceived moral standing of physicians. The prolonged nature of the pandemic exposed tensions between medical recommendations and public expectations. A 2023 essay in the American Medical Association (AMA) Journal of Ethics explores the effect of medical misinformation on public perception of physician morality.  It argued that public debates over medical misinformation blurred the boundary between individual physicians and the profession as a whole. This included instances in which physicians in public roles were accused of spreading misleading information. In a highly polarised environment, disputes over evidence and expertise often fed broader doubts about physicians’ integrity.

What the Decline Reveals

Research on patient adherence suggests that trust in physicians remains closely tied to communication, transparency, and perceptions of professional integrity. A 2022 J Med Internet Res study of 125 U.S. patients found that effective communication and patient education were associated with stronger interpersonal trust. Other research has similarly linked ethical and professional conduct to broader public perceptions of physicians’ moral standing. The pandemic did more than produce a temporary shift in trust. It also showcased how strongly confidence in physicians depends on both interpersonal care and institutional credibility.