As someone who only speaks fluently in Spanish, Paula Valdez worries about going to the doctor. Anytime she’s sick, she knows it’s going to be a struggle to explain her symptoms or concerns.
Valdez, who identifies as a Mexican woman, remembers visiting an English-speaking doctor in Fort Worth to discuss her frequent anxiety attacks and chest pains. She was worried about being misdiagnosed because she couldn’t communicate clearly.
“It’s hard to explain what you’re feeling in another language to someone who doesn’t understand your background,” she said in Spanish. “It scares you into not going back again.”
Like Valdez, people often walk away from a medical experience, creating a mistrust of health systems and their providers.
Medical mistrust is not a recent issue but deeply rooted in historical abuses, systemic racism, ongoing disparities in treatment and limited access to care, said Dr. Gabriela Mustata Wilson, founding co-director of the Multi-Interprofessional Center for Health Informatics at the University of Texas at Arlington.
To combat the issue, the major health systems in Tarrant County are investing in community outreach programs and health initiatives.
History of medical mistrust
In the U.S., 77% of people with disabilities, 69% of people from ethnic minority groups, and 70% of people from the LGBTQ+ community have had experiences that damaged their trust in the health care system, according to a study in Fortune.
Black and Latino communities are two prominent groups with high levels of distrust. An October 2020 poll found that 7 out of 10 Black Americans think they’re treated unfairly by the health care system with 55% saying they distrust it. The Tuskegee Syphilis Experiment is a major historic example of why distrust exists, said Wilson.
Between 1932 and 1972, the U.S. Public Health Service conducted a study that involved 600 Black men, 399 of whom were diagnosed with syphilis, to observe the natural progression of the disease without treatment. Participants were misled about the nature of the study and were told they were receiving treatment for “bad blood.”
“Unethical medical experiments, like the Tuskegee, are always rooted in the (Black) community and they will never forget that,” Wilson said. “When we think about the multigenerational abuse faced during treatment, this trauma is passed from parents to children, because they talk about this.”
A 2022 assessment from Tarrant County Public Health found that more than 11.2% of the Tarrant County population ages 5 and up speak a language other than English at home and speak English with limited proficiency. The percentage is less than the Texas average, but greater than the national average.
“When you think about the Latino population, the language difference hinders the access and quality of care, which can cause mistrust,” Wilson said.
People who distrust health care organizations are more likely to report and experience poor health.
How can health systems tackle mistrust?
No single solution exists to tackling mistrust in health care, but we need a multifaceted approach that starts with recognizing past wrongs, said Wilson.
“You cannot say ‘Let’s forget about the past and start fresh’, that is not the solution,” she said. “You have to understand and be sensitive to what individuals have experienced or are experiencing right now.”
One of the first solutions is to continuously train health care workers to be culturally competent — meet the social, cultural and linguistic needs of patients. A culturally competent health care system can help improve health outcomes and contribute to the elimination of racial and ethnic health disparities, according to the Health Policy Institute.
Another solution is to diversify the demographics of health care professionals. The Association of American Medical Colleges completed a 2018 study that found the majority of active physicians identified as white.
Research shows that a diverse health care workforce can improve patients’ access to care, their perception of the care they receive, and personal health outcomes.
“When a patient sees someone treating them who looks like them and speaks like them, this can really help build that trust between the health care provider and the patient,” said Wilson.
Health systems also need to be transparent in the way they communicate honestly about treatment options with patients. An emphasis on community outreach and access beyond the hospital is important, too, said Wilson.
“It needs to be easy for people to connect with health care providers, and these providers need to understand the cultural and personal needs of these communities,” she said.
Tarrant County efforts
The Report reached out to Baylor Scott & White Health, Cook Children’s Health Care System, JPS Health Network, Medical City Healthcare, and Texas Health Resources to learn more about local efforts to tackle medical mistrust.
Baylor Scott & White is tackling the issue by providing care to underserved and uninsured residents through initiatives outside the hospitals, said Dr. Jeffrey Zsohar, medical director of the Baylor Scott & White community care clinics.
Some of the system’s initiatives include seven community care clinics across North Texas, including one in Fort Worth, diverse staffing, and free educational programs about health and wellness.
“For us, it’s important that we start discussion on how we are not only addressing medical mistrust, but also building trusting relationships with these communities,” he said. “The way we provide care is based on this relational component.”
Kim Brown, director of public relations at Cook Children’s, said the health system focuses on access to pediatric health care for all children through its neighborhood health centers. The centers are built in neighborhoods identified through strategic market analysis as having inadequate access to primary care for children, Brown said.
“Thus, at-risk children are provided with high-quality, comprehensive, and culturally sensitive medical services in their own neighborhoods,” she said in a statement.
Construction is currently underway on Cook Children’s Las Vegas Trail Neighborhood Health Center, a partnership with JPS, as well as at a new neighborhood center in northeast Fort Worth.
JPS provides comprehensive services to patients at one of its 25 neighborhood locations across Tarrant County, said Jessica Virnoche, executive director of communications with JPS Health Network.
Beyond its clinical care, the hospital district’s Community Outreach program has developed community collaborations and partnerships, including the Tarrant Area R.E.D. Bus project and a community health and wellness program in partnership with the city of Fort Worth’s Como Community Health Center.
“The team participates in community events on behalf of JPS, allowing the community to engage with various clinical teams, enrollment specialists, and case management,” she said in a statement.
Through its Community Health Improvement initiative, Texas Health Resources focuses on identifying health disparities through localized data and the social and environmental conditions that affect overall health. The health system’s three priorities include behavioral health, chronic disease and access to health literacy, said Catherine Oliveros, vice president of community health improvement at Texas Health.
Texas Health programs include its mobile health clinics in underserved communities, faith-based community nursing, and food pantries in Tarrant County schools.
“When you’re working with communities to address issues of building trust and addressing mistrust, we have to be committed to being present and visible for the long term,” she said. “We can’t go in for a year and then walk away. It’s gonna take years to turn that around.”
Medical City Fort Worth did not respond to the Report’s multiple requests for comment.
A lot of progress has been made in Tarrant County to tackle mistrust, but there is always room for improvement, UTA’s Wilson said.
“We all need to come up with a strategy that involves everyone from health care providers to policy makers, community leaders and faces in higher education to continue to address the root cause of mistrust,” she said. “We always say it takes a village.”
As for Valdez, she’s still wary of most Fort Worth doctors, but her experiences have improved since she started receiving care from a Spanish-speaking physician at Mercy Clinic of Fort Worth. The center provides free health care to uninsured adults residing in the 76104 and 76110 ZIP codes.
“With this new doctor, I have been feeling more calm, because she understands everything I am telling her and she doesn’t assume anything about my symptoms,” she said in Spanish.
Valdez hopes to see more Spanish-speaking doctors serve her community.
David Moreno is the health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact him at david.moreno@fortworthreport.org or @davidmreports on X.
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