The surge in AI-powered health chatbots has coincided with a sharp drop in public trust in physicians, according to a recent analysis by Robert Shpiner, MD. Patients now arrive at appointments with screenshots from AI tools rather than medical records. Others delay seeking care after finding reassurance from online influencers or digital tools. These behaviors are not entirely new. The pace at which they are growing suggests a deeper shift in how people view the medical system. AI use both reflects and contributes to this shift.
A 50-state survey from 2020 to 2024 revealed a major drop in trust. In April 2020, 71.5% of U.S. adults reported having a lot of trust in physicians and hospitals. By January 2024, that number had fallen to 40.1%. The decline was even steeper for adults without a college degree, with trust dropping by 12 points between 2019 and 2024. These findings paint a clear picture of a public increasingly skeptical of traditional medical authority.
A Surge in AI Tools and Eroding Trust
Dr. Shpiner, a practicing physician for nearly 40 years, explored these trends in an essay. It was published in the Annals of Internal Medicine titled “Why Patients Ask the Chatbot First.” He argues that the rise of AI tools in healthcare is not the root cause of this loss of trust. Rather, it is a sign of a long-simmering disconnect between patients and the medical system. The problem has been building for years. AI adoption is simply a response to that growing gap.
According to Shpiner, trust in healthcare is not just about feelings but is shaped by the mechanics of how care is delivered. It’s influenced by small but significant factors like the speed of phone responses, the ease of scheduling appointments, and how patients are treated during visits. “It’s not just about what we do, but how we do it,” he explained in an interview. Patients remember how they feel in their interactions, not just the advice they receive.
Shpiner also highlighted the role of broader societal factors in this trust gap. Confusing or contradictory government messaging about vaccines and alternative treatments has sown doubt among the public. Social media, he said, amplifies misinformation and conspiracy theories. These further divide patients and providers. When patients start questioning hospitals for their motives — like whether a treatment is cost-driven or experimental — it signals a deepening mistrust. That wasn’t as common in the past.
What Doctors Can Do
Rebuilding Trust Through Physician Adaptation
Shpiner believes that physicians have a role to play in rebuilding trust. They must adapt to the current environment and show they are on the same side as their patients. “If we’re with them now, on this, as opposed to against it, it may be a step toward increasing trust,” he said. That means acknowledging the realities of the digital age. Physicians should not simply resist or condemn patients for turning to alternative tools.
For internal medicine physicians, the challenge is to be more responsive and open in their approach. In his ICU, Shpiner has encountered patients who accuse hospitals of cost-cutting or experimentation — a shift in tone he didn’t see decades ago. Rebuilding trust, he argues, starts with listening, being transparent, and acting in ways that align with patients’ concerns, rather than dismissing the tools and sources they now rely on.
Navigating the AI Landscape Responsibly
Shpiner warned against vilifying AI or treating it as an enemy. While he acknowledged the unregulated nature of the AI space — calling it a “wild west” — he also said more regulation and oversight are necessary. But he stressed that regulation alone won’t fix the problem. Doctors must also reevaluate their role in the evolving healthcare landscape and take steps to bridge the growing divide between medicine and the public.