> Trust is not rebuilt with meta-analyses. It is rebuilt in exam rooms, one patient at a time, by physicians willing to say... "Let’s talk about what the evidence actually shows".... If we can’t have that conversation, we are not practicing medicine.

I agree. But that conversation can't happen where appointments are restricted to 20-minute segments, and trust cannot be established within a system where patients are forcibly changed to different doctors / medical systems based on the business requirements of insurance companies.

The doctors I know (all ~10 I can think of off the top of my head) have left, or are trying to leave, direct patient care. They haven't been allowed to practice medicine, as so defined, for years.

(This is in the USA, by the way. If you live in a country with a different model, count your blessings and fight like hell to keep it.)

[Edit: Actually, two of my acquaintances included in the number above have switched (or thought about it - it's been a couple of years since I saw one of them, and I don't know if he pulled the trigger) to concierge care. Look it up, if you don't know what that means. It may be the last remaining rump of traditional medical practice, but it's not sustainable / scalable, and is arguably a prisoner's dilemma defection which hurts the system as a whole.]

> But that conversation can't happen where appointments are restricted to 20-minute segments, and trust cannot be established within a system where patients are forcibly changed to different doctors / medical systems based on the business requirements of insurance companies.

And the frequency of visits. The recommended one visit every three years for 18-64 year olds isn't going to build much trust.

The secret is to find independent doctors who have their own private practice and who have hospital admit privileges. Also physicians who take cash payment and operate outside a big health organization or who have affiliations with them but don’t answer to them.