Bridging the Gap: Understanding Medical Mistrust and Patient Experiences in OB/GYN Care

Highlight

• High levels of anxiety and negative experiences are common among people receiving OB/GYN care, with minimization of symptoms as the leading cause of dissatisfaction.
• Preference for female OB/GYN clinicians is prevalent, especially among marginalized racial groups.
• Political affiliation and race significantly influence the likelihood of negative OB/GYN experiences and medical mistrust.
• Feeling heard by the clinician is the strongest predictor of patient satisfaction, underscoring the need for patient-centred care to address mistrust and improve engagement.

Background

Medical mistrust remains a substantial barrier to effective healthcare delivery, particularly in women’s reproductive health. Obstetrician/Gynecologist (OB/GYN) care is pivotal for maintaining reproductive health, yet trust issues rooted in historical, social, and systemic factors inhibit optimal engagement. Negative experiences, conscious or unconscious bias, and cultural discordance exacerbate disparities among marginalized populations, including racial minorities and sexual minorities. Understanding how social determinants, political identity, media exposure, and geography intersect to shape patient perceptions in OB/GYN settings is essential for crafting interventions that foster equity and trust.

Study Design

This investigation was a cross-sectional survey conducted online using the Prolific platform, employing a stratified, randomized sampling strategy targeting individuals assigned female at birth, aged 18 to 40, residing in the United States. The survey collected demographic information, political affiliation, history of pregnancy, sexual orientation, race, education level, and geographic location. Key survey domains included experiences and perceptions in OB/GYN care, emotions during care, gender preference for clinicians, and medical mistrust quantified by validated scales. The primary outcomes focused on assessing negative experience prevalence, factors associated with these experiences, and the degree of trust versus mistrust in the healthcare system.

Key Findings

The study analyzed responses from 579 participants, predominantly identifying as women (93%), with 33.9% identifying as LGBTQIA+ and 45.2% having experienced pregnancy.

Emotional Experience and Negative Care Encounters

Anxiety was reported by nearly half of the respondents (46.4%) as the dominant emotion during OB/GYN visits. About one in four (25.8%) recounted having negative experiences. The most frequent cause of dissatisfaction was clinicians minimizing or dismissing patient concerns, accounting for 68.5% of these negative reports. This finding underscores persistent gaps in clinician communication and empathy in OB/GYN care.

Clinician Gender Preference

A significant majority (65.3%) preferred female OB/GYN clinicians. This trend was especially pronounced among Black, Asian, and multiracial participants who expressed racial preferences for clinicians, suggestive of intersecting concerns regarding identity concordance and cultural sensitivity.

Demographic and Social Determinants of Negative Experience and Mistrust

Political affiliation emerged as a strong predictor, with individuals identifying as Republican demonstrating higher odds of negative OB/GYN experiences. Conversely, Asian race and lower educational attainment correlated with lower odds of reporting negative experiences, although these groups still experienced distinct challenges, including elevated medical mistrust among Black respondents and those with lower education levels.

Feeling heard and understood by clinicians was the most powerful predictor of care satisfaction across all groups. This finding highlights that despite complex social variables, fundamental interpersonal dynamics significantly impact patient engagement and trust.

Expert Commentary

This study provides valuable insights into the nuanced interplay of social, political, and cultural forces shaping the patient experience in OB/GYN care. The prominence of anxiety and dismissal effects echoes previous literature calling for enhanced provider communication training and structural changes in care delivery models. The strong preference for female and racially concordant clinicians among marginalized groups may reflect deeper systemic inequities and trust deficits, pointing towards the need for diversity in the healthcare workforce.

Notably, the link between political identity and healthcare experience suggests that broader societal polarization influences patient perceptions and could complicate efforts to build trust. Interventions that promote patient-centred communication while addressing structural and implicit biases could bridge these divides.

Limitations include the cross-sectional design, potential self-selection bias inherent in online survey platforms, and reliance on self-reported measures, which can affect generalizability. Nevertheless, the diverse respondent pool and stratified sampling support the relevance of findings for policy and clinical practice.

Conclusion

Negative experiences and medical mistrust remain prevalent in OB/GYN care, particularly affecting marginalized populations influenced by racial identity, education, and political affiliation. The overwhelming importance of feeling heard by clinicians indicates that patient-centred communication is a critical lever to improve satisfaction, reduce mistrust, and enhance engagement.

Healthcare providers and systems must prioritize empathetic listening, cultural competence, and diversity in clinician workforce to address these disparities. Future research should explore longitudinal outcomes of interventions designed to rebuild trust and examine how intersectional identities impact OB/GYN care engagement.

Funding and Clinical Trials

The original study funding details were not specified. No clinical trial registration was identified.

References

1. Bellon M, Kakkad N, Schneider J, Friedman S, Jalili D, Quinn GP. Medical Mistrust and the Patient Experience: A National Survey on What Shapes Engagement in OB/GYN Care. BJOG. 2026;133(8):1572-1580. PMID: 41667132.

2. Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283-1289.

3. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA. 2002;288(6):756-764.

4. Schwei RJ, Loveland Cook CA, Brandon DT, et al. Changes in attitudes about health care provider bias: Evidence from a US national survey. Health Equity. 2020;4(1):139-146.

5. Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns. 2009;74(3):295-301.