2026 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST In-Training Member Category Winner
2026 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST In-Training Member Category Winner
You Can’ t Prescribe Trust: Reflections from a Third-Year Medical Student
by Emma Heironimus, M4
I
didn’ t realize how quickly I labeled patients in my head until I caught myself thinking,“ Why won’ t she just listen?”
I was on my internal medicine rotation, still early enough in third year that every patient encounter felt like a test; not just of knowledge, but of who I was becoming as a physician. During this rotation, I met Ms. X, a woman in her 50s admitted for uncontrolled diabetes. Her A1c was over 12 %. She had neuropathy and early kidney disease. The plan was to start insulin.
When the team brought it up, she said no: not angrily, just firmly. The resident explained the risks of uncontrolled diabetes and the benefits of insulin. The attending reinforced the recommendation. From a medical standpoint, it made sense. I remember thinking this was one of those straightforward situations we learned about in class: clear indication, clear intervention. But she still declined.
Later that afternoon, I went back to clarify part of her history. Before leaving, I asked,“ Can you help me understand what makes you hesitant about insulin?”
She shrugged at first. Then she said,“ My mom was put on insulin near the end. After that, she was in and out of the hospital. It just felt like things got worse from there.” There was no dramatic pause, no tears: just a matter-of-fact explanation.
It wasn’ t that she thought insulin caused her mother’ s decline. It was that insulin had become associated with it. In her mind, starting insulin meant her diabetes had reached a point she had hoped to avoid. That conversation shifted my understanding. Her refusal wasn’ t about rejecting medical advice. It was about what insulin represented to her.
Up until that point, I had been focused on physiology and outcomes. She was focused on what this decision meant in the context of her life. Once we understood that, the conversation became less about convincing her and more about discussing what insulin would realistically look like for her now: how dosing works, what monitoring involves and how we would follow up. She didn’ t agree immediately. But she asked more questions, and that felt like progress.
Medical hesitancy, I began to understand, is often about stories, not statistics. As I have moved through rotations, I have learned that patients rarely walk into exam rooms as blank slates. They carry family histories, community narratives and personal experiences that shape how they interpret every recommendation. Some of those stories are deeply personal, like Ms. X’ s association between insulin and her mother’ s decline.
Others are collective. In the U. S., the tragedy of the Tuskegee Syphilis Study, where Black men with syphilis were misled and denied treatment by the very system meant to care for them, still shapes how many communities view healthcare institutions. In ethics lectures, we study it as a historical failure that led to reforms in research oversight and informed consent. In clinical settings, however, it surfaces not as a footnote in history, but as context.
That history is not abstract. It appears in the way patients ask questions about research participation. It surfaces when someone hesitates before agreeing to a new vaccine or expresses concern about being“ experimented on.” It influences how recommendations are interpreted, especially when they come from large institutions or government agencies.
8 LOUISVILLE MEDICINE