A split screen illustration symbolizing mistrust between patients and healthcare providers.

Feeling Unheard? Navigating Mistrust in Modern Healthcare

Nico Varela in Health & Wellness November 2025 • 4 min read.

"Unpacking Caller Mistrust in National Telephone Advice Services for Better Care"

In an era dominated by instant information and readily available opinions, the relationship between patients and healthcare providers is evolving rapidly. The rise of national telephone advice services (TANs), designed to streamline access to medical guidance, introduces new dynamics, including a growing sense of mistrust. This article delves into a revealing study published in "Internet Research," which uncovers the complexities of caller mistrust in Swedish Healthcare Direct (SHD), a national TAN service.

The research, conducted by Annica Björkman and Martin Salzmann-Erikson, sheds light on how individuals use online forums to express their experiences and attitudes toward TAN services. By examining these virtual discussions, the study identifies a significant theme: a bidirectional mistrust between callers and nurses. This mistrust not only impacts the immediate interaction but also has broader implications for healthcare compliance and service effectiveness.

Understanding the roots and manifestations of this mistrust is crucial for both patients and healthcare providers. This article aims to unpack the key findings of the study, offering insights into the challenges of modern healthcare communication and providing practical advice for navigating these complex relationships. Whether you're a frequent user of TAN services or a healthcare professional, this analysis will help you foster more trust and improve your overall healthcare journey.

The Scrutinizing Game: Unpacking Bidirectional Mistrust

A split screen illustration symbolizing mistrust between patients and healthcare providers.

The most prominent finding in Björkman and Salzmann-Erikson's study is the prevalence of a “scrutinizing game,” characterized by bidirectional mistrust. Callers express doubts about the nurses' advice, competence, and credibility, while nurses, in turn, may distrust callers' descriptions of symptoms or their adherence to recommendations. This creates a cycle of skepticism that undermines the effectiveness of the healthcare interaction.

Several factors contribute to this phenomenon:

Conflicting Expectations: Callers often seek immediate answers and personalized advice, while nurses may rely on standardized protocols and limited information. This mismatch can lead to frustration and a perception of inadequate care.
Information Overload: The ease of accessing health information online empowers patients but can also create unrealistic expectations and a tendency to second-guess professional advice. Nurses may feel challenged by callers who present themselves as experts based on internet research.
Lack of Personal Connection: Telephone consultations lack the face-to-face interaction that fosters trust and empathy. Callers may perceive nurses as impersonal or uncaring, while nurses may struggle to assess patients' conditions without visual cues.
Systemic Pressures: TAN services operate under pressure to manage high call volumes and streamline patient flows. This can lead to rushed consultations and a perception that nurses are employing “delaying tactics” or “passing the buck” to other healthcare services.

The scrutinizing game is further fueled by instances where callers feel dismissed or disrespected. Forum posts reveal experiences of nurses being perceived as unfriendly, arrogant, or disciplining. This can erode callers' trust in the service and their willingness to follow medical advice. Conversely, nurses may perceive callers as demanding, manipulative, or exaggerating symptoms, leading to a defensive approach.

Building Bridges: Fostering Trust in Healthcare

Addressing the bidirectional mistrust in TAN services requires a multifaceted approach. Healthcare providers should prioritize communication skills training for nurses, emphasizing empathy, active listening, and personalized advice. Clear communication about the limitations of telephone consultations and the rationale behind recommendations can also help manage caller expectations. Additionally, incorporating video consultations could add a valuable dimension of visualization, improving trust and understanding. On the patient side, approaching TAN services with realistic expectations and a willingness to collaborate with healthcare providers can lead to more positive outcomes. By acknowledging and addressing the factors that contribute to mistrust, we can build stronger, more effective healthcare relationships in the digital age.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is bidirectional mistrust in the context of Swedish Healthcare Direct (SHD), and how does it affect the interactions between callers and nurses?

Bidirectional mistrust, as identified in the study of Swedish Healthcare Direct (SHD), is a cycle of skepticism where both callers and nurses harbor doubts. Callers may question the advice, competence, and credibility of nurses. Nurses, in turn, may distrust the accuracy of callers' descriptions of symptoms or their adherence to recommendations. This mutual distrust undermines the effectiveness of the healthcare interaction, potentially leading to misunderstandings, non-compliance with medical advice, and a less positive overall healthcare experience.

What are the key factors contributing to the "scrutinizing game" observed in the interactions within Swedish Healthcare Direct (SHD)?

Several factors fuel the "scrutinizing game" in Swedish Healthcare Direct (SHD). These include conflicting expectations between callers seeking immediate and personalized advice versus nurses using standardized protocols; information overload, where online health information creates unrealistic expectations; lack of personal connection inherent in telephone consultations, hindering trust and empathy; and systemic pressures, such as high call volumes, potentially leading to rushed consultations. These factors combined create an environment where mistrust can easily develop and escalate.

How does the lack of a personal connection in telephone consultations, such as those provided by Swedish Healthcare Direct (SHD), influence the level of trust between callers and nurses?

The absence of face-to-face interaction in services like Swedish Healthcare Direct (SHD) significantly impacts the development of trust. Without visual cues and the ability to observe body language, nurses may find it challenging to accurately assess a caller's condition. Callers, conversely, might perceive nurses as impersonal or uncaring, reducing their willingness to fully trust the advice given. This lack of connection can lead to misunderstandings, misinterpretations, and a breakdown in the rapport necessary for effective healthcare communication.

How can the bidirectional mistrust within national telephone advice services like Swedish Healthcare Direct (SHD) be mitigated to improve healthcare experiences?

Addressing the bidirectional mistrust in services like Swedish Healthcare Direct (SHD) requires a multifaceted strategy. Healthcare providers should prioritize communication skills training for nurses, emphasizing empathy, active listening, and personalized advice. Clear communication about the limitations of telephone consultations and the rationale behind recommendations can also help manage caller expectations. Incorporating video consultations could add a valuable dimension of visualization, improving trust and understanding. On the patient side, approaching services with realistic expectations and a willingness to collaborate with healthcare providers can lead to more positive outcomes.

What role does information overload play in the bidirectional mistrust dynamic between callers and nurses within Swedish Healthcare Direct (SHD), and how does it challenge healthcare professionals?

Information overload, fueled by the ease of accessing health information online, significantly impacts the dynamics within Swedish Healthcare Direct (SHD). While empowering patients, it can also create unrealistic expectations and a tendency to second-guess professional advice. Callers, armed with online research, may challenge or disagree with the advice provided by nurses. Nurses may feel challenged by callers who present themselves as experts based on internet research, potentially leading to defensiveness and a breakdown in trust. This dynamic highlights the need for healthcare professionals to be prepared to address informed, but sometimes misinformed, patients, and to effectively communicate the rationale behind their recommendations.