How many times have we heard “Whatever you say doc, I know you will do right by me. You always have and I know you will.” Or, “What do you think, doctor? Do you think I should do this?” Or, “Thanks, doc, I am so glad you are here.” These statements imply trust, the sacred trust between physician and patient and an exceedingly complex topic.

While it has been important to move away from medical paternalism and engage as partners with our patients, we are hearing more hesitancy, challenges (“Google says …”), and threats to one’s personal safety or authority (“I will go to your [boss/state medical board]…”).

How did this come about?

Communication between physicians and patients has been trending in this direction since before the pandemic. Many factors have led to increased skepticism of physician advice, such as some physician behaviors on social media, and of course the pandemic. In addition, primary care, a key feature of high-quality care has been systematically minimized, and visits have been shortened or simply are not available. When, and where, can patients raise concerns, fears, and most importantly, be listened to? How many of you schedule a patient, someone you know routinely takes longer than others, right before lunch, or at the end of the day, so if the appointment ran over, the impact on other patients would be minimized? How sustainable is this, really?

That space of sacred trust and communication has been squeezed, and in spite of this, surveys suggest that patient trust in their individual physicians remains high.

What else has been going on?

On June 9, the entire expert physician and scientist membership of the Advisory Committee on Immunization Practices, or ACIP, was fired, ironically, in the name of “rebuilding trust.” The seventeen fired members were replaced two days later by eight individuals with little or no clinical experience, some known to hold anti-vaccine positions. On August 5, the liaison members of ACIP were summarily barred from participation, which included representation from organizations such as the American Medical Association (AMA), American College of Physicians (ACP), American Academy of Pediatrics, Infectious Disease Society of America, and others. Again, this was in the name of “eliminating special interest groups.” Apparently, to some in the federal government, physician scientist expertise has become a “special interest” of concern, rather than one of value.

Why is this important? ACIP sets immunization standards in the U.S. Vaccination endorsement by ACIP safeguards broad access to vaccines through insurance programs. ACIP makes weighty decisions, with significant health implications for individual patients and the U.S. population.

The reaction by physician groups was swift: On June 10, one day after the firing of the ACIP membership, the AMA House of Delegates endorsed an emergency resolution to immediately reinstate all members of the ACIP and asked the Senate to investigate RFK Jr., Secretary of Health and Human Services, regarding his actions involving ACIP and the CDC. On July 7, multiple specialty societies, including ACP, joined as plaintiffs in a lawsuit American Academy of Pediatrics vs. Robert F. Kennedy, Jr., protesting his unilateral decision to remove the COVID-19 vaccine from recommendations for children and in pregnancy, alarming experts. The lead plaintiff, Jane Doe, is a pregnant physician who, by virtue of this decision, is at risk for being unable to receive a vaccine.

Superman has X-ray vision. We also possess a unique lens on life and disease: as physicians, we know, for example, that if a vulnerable person is exposed to measles, they are overwhelmingly likely to contract measles. Often, but not always, we can see what is coming. Similarly, even though we may not be in the lab working on new mRNA vaccines, we know the harmful downstream consequences of cancelling contracts and pulling funding for such work.

So, what do we do?

We remain engaged with our professional societies, such as ACP. ACP follows scientific and rigorous processes for developing evidence-based clinical guidelines and clinical recommendations. It is the only U.S. organization and physician specialty society in the world to be designated as a GRADE Center and AGREE Center; it is also a founding member of the Cochrane U.S. Network.

The Vaccine Integrity Project, established this spring by respected physician scientists and vaccine experts, could become the lead trusted voice for vaccine and vaccination information in the U.S., as an alternative to the tainted ACIP. Stay tuned.

The necessity for new models of health communication has become abundantly clear. The top-down model of communication from researcher to journal to institution to website to the lay public is not working. We must train our rising learners, and each other, to better communicate directly with the public about important health topics.

We advocate to protect that sacred space of patient-physician trust, and to mitigate what we see coming. We uphold our Hippocratic oath.

And finally, the late physician and global humanitarian Paul Farmer, MD, PhD, who left us much too soon, said: “Trust is built one patient at a time.” Paul helped establish a far-reaching, impactful global organization combatting poverty and disease which continues to inspire today. “One patient at a time,” combined with compassion and empathy, was his simple roadmap: This can be our roadmap, too.

Janet A. Jokela, MD, MPH, completed her term as ACP Treasurer at IM 2025. She serves as professor and senior associate dean of engagement at the Carle Illinois College of Medicine, Urbana, IL. She may be reached on BlueSky @drjanetj.bsky.social.

The American College of Physicians is the largest medical specialty organization in the United States, boasting members in over 145 countries worldwide. ACP’s membership encompasses 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who utilize scientific knowledge and clinical expertise for diagnosing, treating, and providing compassionate care to adults, spanning from those in good health to individuals with complex illnesses. Stay connected with ACP on X @ACPIMPhysicians, Facebook, LinkedIn, and Instagram @acpimphysicians.