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Trust is the Treatment
by Amber Pendleton, MD
Our academic general pediatrics team believes, deeply and without hesitation, that good medicine extends beyond the exam room. Health is shaped as much by food security, housing stability and mental well-being as it is by vaccines, growth charts and prescriptions. Passionate pediatricians prescribe resources as seamlessly as they prescribe medicines. Through grassroot efforts and system support, social workers sit alongside physicians. Community health workers help families navigate resources. A food pantry is stocked and ready. On paper, it is the kind of wraparound care model often held up as one way to deeply improve child health.
And yet, something troubling kept happening.
Families who clearly needed help hesitated to accept it. Parents declined food support even when we knew their cupboards were bare. Caregivers skirted questions about housing instability, utilities or safety. They smiled politely, said“ We’ re okay,” and moved on, sometimes while visibly exhausted and having a hard time.
At first, I wondered if we were asking the wrong questions or asking them at the wrong time. But the pattern persisted. And eventually, we began to understand: many families were not declining help because they did not need it. They were declining it because they were afraid.
Afraid of us.
Afraid that admitting need, especially basic needs like food or heat, would trigger a call to Child Protective Services. Afraid that honesty might be interpreted as neglect. Afraid that their children could be taken away. One encounter crystallized this reality for me.
I met a mother for the first time when she brought her newborn to clinic. I noticed they had missed their initial appointment over the holidays. Wanting to check in, I gently asked if everything had been okay. She hesitated, then quietly told me they had lost heat in their home for eight days during a dangerously bitter cold stretch. She described
34 LOUISVILLE MEDICINE shaking so hard it was hard to hold her baby, but she kept her warm as best she could. She had been terrified, not just of the cold, but of being discovered. She worried that if she told anyone in the clinic, we would call CPS. She worried she could lose her child.
So, she stayed silent. She stayed home. She endured.
That moment stopped me cold. Here was a mother doing everything she could to protect her newborn, including protecting them from the very systems meant to help. Her fear was not irrational. It was informed by stories she had heard, experiences in her community and a healthcare system that has not always distinguished between poverty and neglect.
This is one of the roots of medical hesitancy we rarely name, not hesitancy toward vaccines or medications alone, but hesitancy toward disclosure, toward truth-telling, toward trusting clinicians with the realities of daily life.
I realized then that if we truly wanted to overcome medical hesitancy, we had to do more than offer resources. We had to understand where mistrust comes from, and honor it.
So, I set out to listen.
Partnering with colleagues at the School of Public Health, we designed a qualitative research project focused on one simple goal: to hear directly from parents and community members about their experiences with healthcare. We did not start with hypotheses. We started with questions, and with humility.
Over months, we gathered more than 14 hours of conversations with parents and community experts, hosted in spaces that felt safe and familiar to them, places where people could speak freely without fear or judgment.
What I heard changed me.
The fear was deep and layered. Many parents described devastating healthcare experiences, moments when they felt dismissed, disrespected
OPINION