Medical Mistrust Is a Rational Response

This post is part of a Black History Month series examining the medical history, biology, and systems that shape health outcomes for Black patients, from historical context to evidence-based prevention

Medical mistrust is often discussed as a barrier to care. Something to overcome. Something patients need to “get past.”

That framing misses an important truth.

For many Black patients and other marginalized populations, medical mistrust is not irrational. It is learned.

It is shaped by history, reinforced by lived experience, and maintained when concerns are dismissed rather than addressed. Understanding this matters, because mistrust is not just an emotional state. It has measurable effects on health outcomes.

Mistrust Did Not Come From Nowhere

As discussed in the previous post, events like the Tuskegee Syphilis Study were not isolated ethical failures. They were part of a broader pattern in which Black patients were excluded from care, studied without consent, or denied treatment altogether.

Those events did not occur in ancient history. They occurred within the lifetime of patients still alive today, and within families whose stories are passed down.

Expecting trust without acknowledging that history is not evidence-based. It is unrealistic.

What the Data Actually Show

Decades of peer-reviewed research demonstrate that medical mistrust is associated with:

• Lower participation in preventive screening

• Delayed presentation for acute illness

• Reduced adherence to long-term medications

• Lower enrollment in clinical trials

• Shorter, less engaged clinical encounters

These patterns are often labeled as “noncompliance” or “poor follow-up.” In reality, they frequently reflect protective behavior in response to prior harm or dismissal.

When Mistrust Is Reinforced in Modern Care

Mistrust is not sustained by history alone. It is reinforced in everyday clinical interactions when patients experience:

• Symptoms minimized or attributed to anxiety without evaluation

• Pain undertreated or questioned

• Concerns dismissed as exaggeration

• Limited explanation of risks, benefits, or alternatives

• Rushed visits where questions are discouraged

Each of these experiences may seem minor in isolation. Over time, they accumulate.

From a patient’s perspective, mistrust is not a rejection of medicine. It is often a response to repeated signals that their experience is not being fully heard.

Why Calling It “Noncompliance” Is a Clinical Error

Labeling mistrust as noncompliance shifts responsibility away from systems and clinicians and onto patients alone.

More importantly, it prevents improvement.

When mistrust is mischaracterized, clinicians may respond by:

• Becoming more directive rather than more transparent

• Spending less time explaining care plans

• Assuming lack of interest rather than unresolved concern

This deepens the very problem it attempts to solve.

What Clinicians Can Do Differently

Rebuilding trust does not require perfection. It requires consistency.

Clinicians can:

• Explain reasoning, not just recommendations

• Name uncertainty when it exists

• Invite questions without defensiveness

• Avoid dismissive language, even unintentionally

• Document concerns clearly and follow up

Trust is not built in a single visit. It is built through reliable, respectful behavior over time.

What Patients Can Do, Especially in Marginalized Communities

Patients should never be responsible for correcting systemic failures. Still, there are practical steps that can help patients protect their health and navigate care more effectively.

Patients can:

• Ask for clear explanations and documentation

• Bring a trusted person to important visits when possible

• Seek second opinions without guilt

• Pay attention to patterns of dismissal, not just single encounters

• Remember that caution and questions are not signs of disinterest

Hesitation is often a rational response to experience, not a lack of engagement in health.

A Rational Response Deserves a Rational Solution

Medical mistrust is not a character flaw. It is not ignorance. It is not something to be corrected with reassurance alone.

It is a signal.

If medicine wants trust, it must earn it through transparency, accountability, and humility. That work is ongoing. Avoiding it does not make mistrust disappear. Addressing it honestly gives medicine a chance to improve.

In the next post, we will examine how cardiometabolic disease, particularly hypertension and kidney disease, disproportionately affects Black patients, and what the evidence actually shows about prevention and treatment.

Eric Benjamin, PA-C
Preventive & Metabolic Health
Eat well. Move often. Age boldly.