Why Are So Many Women Distrustful of the Healthcare System? How Trust Gets Broken and Rebuilt
Trust breaks down when it takes women 7-11 years to get their endometriosis diagnosis.1,2 Or when they’re dismissed during appointments, then handed a prescription without being provided a thorough explanation of why. Trust breaks down when practitioners are half listening, barely glancing up from their screen, and somehow their conclusion is still “lose some weight.”
It rebuilds through the process of shared decision-making and with providers who ask what patients want and let patients lead their own care.
In part one, we looked at some of the factors that have contributed to women's distrust of the healthcare system. Here in part two, we’ll talk about why trust matters so much in the patient-provider relationship and what rebuilds it once it's broken.
What Makes Your Provider Trustworthy?
Research on hormonal health counseling consistently defines trust as a combination of three things:3
- Feeling heard
- Feeling respected
- Feeling like a genuine participant in decisions about your own body
When one of those is missing, patients disengage. They stop asking questions, stop reporting side effects, and might even stop treatment altogether.
This benefits no one.
So many hormonal health decisions require a prescription or a provider visit to even begin. Women don't get to self-select their care the way they might choose a supplement or a wellness app. A provider sits between a woman and her options, which means that provider has real influence, for better or worse, over which treatment she ends up choosing and whether she sticks with it.
If you’re a practitioner and wondering why so many of your patients struggle with sticking to their treatment plan, it might be time to self-reflect a little on what counseling looks like.
Why Do Diagnostic Delays Erode Trust?
Every delay in getting a real answer teaches a patient that the system isn't built to hear her.
A diagnostic delay is so much more than just a scheduling inconvenience. Although the burden of repeat appointments, tests and referrals is exhausting and a very real barrier to care. Especially for patients with comorbid conditions or disabilities.
Each dismissed symptom, each "let's just wait and see," and each visit that ends without an explanation adds up. Over time, women begin to expect to be doubted before they even walk into an appointment. That expectation can impact behavior. Patients might start to under-report symptoms, downplay pain, or stop mentioning concerns they assume won't be taken seriously anyway.
Research has found that the quality of a single counseling conversation can shape whether a woman ends up using a treatment correctly and consistently.4-6 Naturally, this affects how well her symptoms are managed. Delay and dismissal have significant downstream clinical consequences.
Why Do So Many Women Feel Dismissed by Their Provider?
Too many clinical encounters are still built around the provider's expertise instead of the patient's experience, even when providers don't realize it. Provider expertise absolutely matters. But all that expertise is essentially useless if your patient no longer trusts what you have to say.
Research on hormonal health counseling reveals an alarming pattern. Women frequently leave appointments having been handed a prescription without a clear explanation of why that option was chosen over another, or what trade-offs it involves.4-6 Societal bias and structural barriers shape clinical conversations in ways providers themselves often don't recognize, simply because of the power imbalance built into the exam room.7
One striking example comes from a 2021 study that interviewed providers directly about patient challenges with hormonal treatment.7 Providers often attributed patient hesitation or "non-adherence" to cultural difference rather than legitimate preference.7 One provider described more educated patients as "fairly demanding" for asking detailed questions, while describing patients with lower socioeconomic status as harder to work with because of adherence rather than examining whether the counseling itself was meeting either group's needs.7 The same research found that certain long-acting treatments were recommended more often to women from marginalized groups, with less consideration given to their stated preferences about starting or stopping that treatment.7
The pattern woven through all this distrust is care that prioritizes provider judgement in place of the patient’s voice. Both are important and should be considered.
How Do Healthcare Providers Build Trust Back?
Shared decision-making (SDM) is a model of care where the patient and provider work together as partners. The provider brings medical expertise, the patient brings her own preferences, values, and lived experience, and the treatment decision is made collaboratively rather than prescriptively.8
Unlike a lot of clinical decision-making, SDM in hormonal health is a collaborative and ongoing conversation.
Can Providers Build Trust in a Single Appointment?
Two behaviors matter more than any other, according to research tracking real counseling visits.6 Starting the relationship well and asking what the patient wants before recommending anything.6
A large study found two provider behaviors stood out as most meaningful to women:6
- Investing in the beginning: Taking time early in the visit to build rapport and trust, before jumping into clinical recommendations
- Eliciting the patient's perspective: Actively asking about the patient's circumstances and preferences, and using that to guide the conversation
Women who experienced high-quality, interpersonal counseling in that study were significantly more likely to be using their chosen treatment effectively six months later.6 More recent research found the same pattern extends beyond the initial choice: women who felt heard, respected, and involved in the decision were more satisfied with their treatment and more likely to stick with it long-term.3
There's a flip side too. Later research found that patients who sensed their provider had a preferred outcome in mind, even an unspoken one, reported lower satisfaction with their care.9 Neutrality is one of the clearest predictors of whether a patient trusts the process at all.
What Are Key Principles of Trust Building in Healthcare?
If you’ve been reading along as a provider and wondering how you can do better, here are some guidelines:
- Start with the relationship, not the recommendation. Trust-building happens before any clinical advice is given.
- Ask before you advise. Understand the patient's preferences, lifestyle, and concerns before presenting options. Acknowledge their hesitations and objections.
- Present options without steering. Lay out the full range of appropriate choices, not just the provider's default.
- Explain the "why." Every recommendation should come with a clear, plain-language reason.
- Make space for follow-up. Trust isn't built in one visit. It's reinforced (or undone) in every interaction after.
Where Can You Find Trustworthy Healthcare?
At July Health, we’ve designed our care models around what matters to women the most. Our practitioners invest in relationships by learning about our patient’s needs, wants and barriers. We never let our assumptions guide care and ensure that sessions are a collaborative effort that keep patients engaged.
This means judgment-free conversations about your symptoms and goals, with solutions that make sense for your lifestyle. We offer clear explanations behind every option we discuss and take the time to make sure that you’re comfortable and on board with the plan.
You're not expected to already know the "right" answer walking in, and you won't be steered toward one before you've had a real say.
For too many women, the healthcare system carries baggage. We know that you’ve been denied and minimized before. It doesn’t have to be that way.
Book a session today to see what real shared decision making can feel like.
This is Part 2 in our series on trust in women’s healthcare. Check out Part 1 if you missed it.
This article is for informational purposes only and isn't a substitute for individualized medical advice. Talk to your doctor before starting or stopping any medication.
References:
1. Li W, Feng H, Ye Q. Factors contributing to the delayed diagnosis of endometriosis—a systematic review and meta-analysis. Front Med. 2025;12. doi:10.3389/fmed.2025.1576490
2. De Corte P, Klinghardt M, von Stockum S, Heinemann K. Time to Diagnose Endometriosis: Current Status, Challenges and Regional Characteristics—A Systematic Literature Review. BJOG: An International Journal of Obstetrics & Gynaecology. 2025;132(2):118-130. doi:10.1111/1471-0528.17973
3. Hale N, Dehlendorf C, Smith MG, Stapleton J, McCartt P, Khoury AJ. Contraceptive counseling, method satisfaction, and planned method continuation among women in the U.S. southeast. Contraception. 2024;132:110365. doi:10.1016/j.contraception.2024.110365
4. Dehlendorf C, Levy K, Kelley A, Grumbach K, Steinauer J. Women’s preferences for contraceptive counseling and decision making. Contraception. 2013;88(2):250-256. doi:10.1016/j.contraception.2012.10.012
5. Dehlendorf C, Krajewski C, Borrero S. Contraceptive Counseling: Best Practices to Ensure Quality Communication and Enable Effective Contraceptive Use. Clinical Obstetrics and Gynecology. 2014;57(4):659. doi:10.1097/GRF.0000000000000059
6. Dehlendorf C, Henderson JT, Vittinghoff E, et al. Association of the quality of interpersonal care during family planning counseling with contraceptive use. Am J Obstet Gynecol. 2016;215(1):78.e1-9. doi:10.1016/j.ajog.2016.01.173
7. Mann ES, Chen AM, Johnson CL. Doctor knows best? Provider bias in the context of contraceptive counseling in the United States. Contraception. 2022;110:66-70. doi:10.1016/j.contraception.2021.11.009
8. Chen M, Lindley A, Kimport K, Dehlendorf C. An in-depth analysis of the use of shared decision making in contraceptive counseling. Contraception. 2019;99(3):187-191. doi:10.1016/j.contraception.2018.11.009
9. Dehlendorf C, Grumbach K, Schmittdiel JA, Steinauer J. Shared decision making in contraceptive counseling. Contraception. 2017;95(5):452-455. doi:10.1016/j.contraception.2016.12.010
