Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

6 ways to address Black mistrust in medicine


We must work toward establishing trust with all of our patients instead of assuming it already exists.

“Remember the Tuskegee experiment?”


That was my uncle’s response when I tried to convince him to see a doctor and get the flu shot. Despite my best efforts to reassure him that this was a standard form of preventative care, I knew he was right. I knew that he, among many other Black people, kept the Tuskegee experiment in mind when encountering medical professionals.


As a Black woman who chose to pursue medicine, I witness far too often how the painful history of Black people and medicine continues to plague this field on a daily basis. The Tuskegee study is just one historical example of medicine’s intentional harm and experimentation on Black bodies. History has taught us that the “standard” care for Black people, for many years, was meant to be inferior and cruel. Our Black patients, from various educational, socioeconomic, and ethnic backgrounds, remember this. And as medical professionals, we should remember this too.


Here are six ways to address Black mistrust in medicine:


1. Acknowledge that Black mistrust is real.

It’s real and it isn’t your patient’s fault. Black mistrust is the result of unresolved abuse and exploitation of Black people by medical professionals. We can’t expect Black people to willingly trust a system designed to inflict harm, especially since the medical institution has yet to fully acknowledge that history. Failing to acknowledge Black mistrust can lead to inadequate patient care that leaves Black people discouraged, traumatized, and even more apprehensive toward the medical field.


2. Recognize what Black mistrust may look like.

It may be the “difficult” patient who refuses treatment. It may be the protective family member who asks a lot of questions. It may be the defensive patient who read about their symptoms before coming to see you and want to know every detail about their care. It may sound like, “why are you doing that test? What are you injecting me with?”


3. Realize that nobody is obligated to trust someone just because they hold the title “Doctor.”

Trust is earned, not assumed. Internalize this. Work towards establishing trust instead of assuming it already exists—because there’s a good chance that it doesn’t.


4. Read the room.

If you can sense that someone is hesitant, say something. “What questions do you have for me?” “I can tell you’re a little uncomfortable with this.” Acknowledge that uncomfortable feeling. Break down that barrier.


5. Validate.

Listen without interruption for at least 30 seconds. If someone is crying, hand them a tissue. If family members are present, greet them and ask for their perspective. Spend an extra minute or two explaining what tests you’d like to order and why, their diagnosis, medications, and anything else pertinent to their care.


6. Hire more Black doctors.

It’s been published and proven that Black people have better outcomes with Black doctors. So hire more Black doctors. Work towards creating an anti-racist environment and recruit more Black medical students, residents, and faculty. Representation doesn’t only matter—it saves lives and improves clinical outcomes.









This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.