During the height of the Covid-19 pandemic, I walked into an exam room in the urgent clinic where I worked and introduced myself to a young Black woman struggling to breathe.
Before I could continue, she stopped me.
“Can I ask you a question?”
“Of course.”
“Are you Black?”
I was covered head to toe in personal protective equipment, which mostly obscured my face, but I nodded my head up and down and gave her a muffled “yes.”
She visibly relaxed, exhaled and said, “Thank you, doc. I just want to make sure I’m listened to.”
It was a reminder of what many Black patients carry with them into the exam room: the hope that this time, they will be seen, heard and believed.
That moment has stayed with me for years, not because her reaction surprised me, but because it was a reminder of what many Black patients carry with them into the exam room: the hope that this time, they will be seen, heard and believed.
Too often, we characterize Black patients hoping for something different as a consequence of “medical mistrust,” but after nearly two decades as an emergency medicine physician, and as a Black patient myself, I now believe that phrase subtly, but unfairly, places the burden on Black patients, in that it suggests they are wrong not to trust the healthcare system. We ought to, instead, be pointing out what the healthcare system has done, historically and in the present day, to make so many Black people wary.
The problem is not “medical mistrust”; it’s “institutional untrustworthiness.”
Black Americans’ concerns about medicine and healthcare are rooted in lived experience, collective memory and documented history: from Henrietta Lacks, whose cancer cells were taken without her knowledge or consent and later commercialized for medical research, to the United States Public Health Service Study of Untreated Syphilis in the Negro Male at Tuskegee and Macon County, Alabama, to Dr. J. Marion Sims’ experimentation on enslaved Black women, including Anarcha, Betsy and Lucy.
And evidence of that institutional untrustworthiness keeps surfacing. Just last week, The New York Times reported that in the 1960s, two Black infants in Washington, D.C., died after they were enrolled in an National Institutes of Health-sponsored experimental vaccine study without their families’ knowledge or consent. The families of Ross Otto Hambrick and Victor Marcellus King, who recently learned what happened from a reporter who found the babies’ names in a doctor’s lab notes, filed a lawsuit against the federal government.
This legacy is compounded by what Black patients experience now: documented undertreatment of pain, persistentmaternal health disparities, inequities in diagnosis and outcomes and the everyday experience of being minimized, talked over or not heard by healthcare providers.
That’s why a recent controversy hits so deeply: An online directory to help connect Black patients to Black doctors has been sued by an anti-DEI group and a white physician who says he was denied inclusion because he’s not Black.
Dr. Dina Strachan founded “Find A Black Doctor” to help patients connect with Black physicians and dentists.
Dr. Dina Strachan, a board-certified dermatologist, founded “Find A Black Doctor” in 2005 to help patients connect with Black physicians and dentists. Only about 3% of U.S. dermatologists are Black. The lawsuit, filed by a white dermatologist and the group Do No Harm, is offensive because it ignores the truth that patients seek alignment in healthcare all the time. Consider the women who seek women OB-GYNs, the LGBTQ+ patients who look for affirming clinicians and the many people who search for physicians who speak their language or understand their culture.
They conduct those searches because healthcare is not simply about expertise. It’s also about trust, communication and psychological safety. Directories such as Find A Black Doctor weren’t created to suggest that Black physicians are inherently better doctors, but to help patients feel more understood in a healthcare system where being seen, heard and believed has not always been guaranteed.
Research suggests that racial concordance between patients and physicians can improve communication, trust, patient satisfaction and, in some cases, health outcomes. A widely cited 2020 study found that Black newborns were significantly more likely to survive when cared for by Black physicians. In other words, for some patients, shared lived experience and cultural understanding have a life-or-death significance.
In dermatology in particular, Black patients have long navigated a field in which darker skin tones have been underrepresented in medical education and textbooks, and that underrepresentation has contributed to delayed diagnoses, missed diagnoses and unequal care. Seeking out a physician who may better understand one’s lived experience, concerns or even how disease presents on darker skin is not discrimination. For many patients, it’s self-advocacy.
Too many people are only willing to acknowledge historical injustice when it stays safely in the past. But the news of the lawsuit from the families whose babies died is an example of a medical outrage not staying in the past, and Black patients’ searches for Black doctors is an example of the work they are doing to keep racism from killing them.
Trust isn’t something institutions can demand, nor is it restored through messaging alone. Trust is built through experience, accountability and a culture that makes patients feel respected and safe.
So instead of asking why Black communities mistrust healthcare, we should ask what it would look like for healthcare institutions to finally become trustworthy — while also respecting the ways communities have learned to better protect themselves in the meantime.
Dr. Uché Blackstock
Uché Blackstock, M.D., is the founder and CEO of Advancing Health Equity, best-selling author of “LEGACY: A Black Physician Reckons with Racism in Medicine” and a former MSNBC and NBC News medical contributor.