OPINION
or harmed. Those experiences rippled forward, shaping how they approached healthcare not only for themselves but also for their children. For some, a traumatic birth experience created a lifelong wariness of medical systems. For others, a single interaction with a judgmental provider closed a door permanently.
Communities that have experienced discrimination described a longstanding awareness that systems do not treat everyone fairly. Even when CPS had never been involved in their own lives, the stories traveled: a cousin, a neighbor, a friend of a friend. The lesson absorbed was clear: be careful what you say. Protect your children by staying quiet.
What struck me most was not anger or accusation. It was clarity. Parents were not asking for perfection. They were asking for trust.
They wanted consistent relationships with providers who knew them beyond a problem list. They wanted transparency, especially about child protective services. What triggers a call? What does not? Who decides? Silence around these questions, they told us, only deepened fear. Not knowing was often worse than hearing the truth.
They also described a kind of care that felt compassionate rather than interrogative, essentially trauma-informed care. This approach to healthcare asks us to shift a fundamental question. Instead of asking, What’ s wrong with you? we ask, What happened to you? That shift, from judgment to curiosity, from efficiency to presence, is not abstract. It plays out in exam rooms every day. It is the difference between documenting“ noncompliant” and asking why a family struggled to return. It is the difference between racing through a checklist and pausing when someone shares something painful.
I think often about the moments we miss. During a family history, a parent mentions that their mother died last year. How easy it is, how routine, to move directly to age and cause of death. Yet in doing so, we risk sending an unintended message: your grief is data, not something to be held. It takes only seconds to do something different. To say,“ That sounds incredibly hard. Are you doing okay?” Those seconds matter. They signal that this is a place where truth is safe.
Parents also told us they want physicians who“ prescribe community” as readily as we prescribe medication. They want us to know local resources not as brochures, but as relationships. They want us to step outside the clinic walls, to meet families where they are and to recognize the village that supports them.
And perhaps most importantly, they want us to be unscripted.
When families share hard truths, about hunger, fear or loss, they want genuine kindness, not rehearsed empathy.“ Thank you for telling me.”“ I can’ t imagine how hard that must be.”“ What does help look like right now?” These words do not require extra time. They require intention.
Overcoming medical hesitancy, I have learned, is not about persuading families to trust us. It is about making ourselves trustworthy.
That means naming past harms, even when we did not personally cause them. It means being explicit about how information is used, rather than hiding behind vague reassurances. It means recognizing that fear is often protective, and that silence can be a survival strategy.
After listening to the voices of our community, I am changing how I ask questions. Now, I explain why I ask about food and housing, and what I do, and do not, do with that information. I tell families clearly that accepting help means that they are supporting their family. I invite conversation about fear instead of pretending it does not exist. I teach trainees that excellence in medicine is not only diagnostic accuracy, but relational skill, that listening is itself an intervention.
The mother who lost heat for eight days did not need a lecture on safety. She needed reassurance that telling the truth would not cost her child. She needed partnership, not surveillance.
Listening, however, cannot end within the walls of the clinic. If fear is shaped by systems, then rebuilding trust requires engaging those systems together. Carrying the voices I heard, I sought dialogue with leaders in child protective services and healthcare, not to assign fault, but to share insight and learn alongside them. Parents spoke clearly about where trust fractures and where it might be restored. When lived experience informs policy and practice, transparency grows, assumptions soften and shared goals come back into focus. In partnership, we can strengthen systems that protect children while also honoring families, reducing fear without diminishing safety.
This work asks us to embrace a broader vision of our role as physicians: not only to deliver care, but to steward trust; not only to diagnose illness, but to confront the conditions that keep families silent. It calls for humility, curiosity and courage, qualities that have long defined the best of our profession.
Richard Spear, MD, understood that medicine is, at its core, a human endeavor: grounded in ethics, compassion and responsibility to both patients and communities. To honor that legacy is to recognize that technical excellence alone is insufficient. We must also ask whether our systems invite honesty, whether our words convey safety and whether our presence earns trust.
Medical hesitancy takes root in fear and accumulated harm. If we want different outcomes, we must be willing to tend to what lies beneath the surface. That work is slow and deeply relational. It requires humility, and a willingness to be changed by what we hear. When we do, families begin to speak. Needs emerge sooner. Care becomes truly comprehensive, not because we have added more resources, but because people finally feel safe enough to accept them.
That is how we overcome the challenge of medical hesitancy, not by asking patients to be braver, but by making our care worthy of their trust.
This essay was a submission to the 2026 Richard Spear, MD, Memorial Essay Contest.
Dr. Pendleton is a pediatrician with Norton Children’ s Medical Group – Novak Center and a Professor at the University of Louisville School of Medicine Department of Pediatrics Division of General Pediatrics.
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