Distrust of the medical profession and other components of the healthcare system may interfere with a patient's ability to make a good decision. Distrust arises when physicians are no longer seen as committed to acting in their patients' best interest.41 This situation may occur when patients are concerned about physician motives, for example, cost-containment, or have had prior experiences of failed expecta-tions.42 Largely anecdotal evidence suggests that distrust is most prevalent among minority groups in the United States, in part because of both historical and current examples of racism within the medical system.43 Although some level of skepticism may encourage patients to become involved in their medical decisions, high levels of distrust of the healthcare system may lead patients to discount the potential benefits of medical treatment and avoid medical care. Low levels of trust may also interfere with effective physician-patient relationships, making it more difficult and less rewarding for physicians to devote time and energy to effective participatory decision making.

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