He sat in my office chair, stiff as stone. Shoulders hunched forward, cap pulled low, eyes darting—not in aggression, but in deep discomfort. His hands fidgeted with the bill of that hat, picking at a frayed edge.
He didn’t want to be there. Every part of his body told me that.
He was a Black man in his early 50s, a long-haul truck driver who hadn’t seen a doctor in years. Something—pain, maybe a friend’s urging, or a gut feeling—had finally nudged him in. Bloodwork was drawn. His PSA was alarmingly high.
When I told him, he went quiet.
I tried to soften the moment with warmth and clarity. I leaned in, not just physically but emotionally. I wanted him to know I cared. That I wasn’t just a physician checking boxes—I was a human deeply concerned for another. But I also had to be careful. I didn’t want to alarm him so much that he never came back. Fear, I’ve learned, can be a wall that shuts the door on care entirely.
Still, the facts couldn’t be ignored. His prostate exam felt firm—concerning for cancer. I explained the next steps: an MRI followed by a biopsy, if indicated.
He asked me, almost pleadingly, “Is there another test you can do—less invasive?”
I hated that I had to say no. I could see it in his face: the dread of procedures, the disruption to his work, the mistrust brewing beneath the surface. He nodded slowly, said he would try to get the MRI. He never scheduled it.
I had my nurse call. Again and again. Messages left, texts unread. When he finally picked up, he rattled off reasons—none of them untrue. He couldn’t miss work. He was always on the road. The MRI place was too far. He didn’t have time.
We tried to meet him where he was—literally. Found locations closer to his routes, worked around his schedule. Still, weeks passed. Then months. Then silence.
And now?
I don’t know. But my gut tells me the cancer is growing. That we missed the window to act. That fear won.
This isn’t just about one man.
According to the American Cancer Society, Black men are 70% more likely to be diagnosed with prostate cancer than white men and over twice as likely to die from it (ACS, 2023). The reasons are complex—genetics may play a role—but much of it is structural: later diagnoses, fewer screenings, delayed treatment, and a deeply rooted mistrust of the medical system.
That mistrust isn’t imagined—it’s inherited, learned, and unfortunately reinforced by real experiences. From the Tuskegee syphilis study to modern-day disparities in pain management, maternal mortality, and access to specialty care, Black communities have been repeatedly underserved and overlooked.
During COVID, we saw how deep the divide ran. Many of my Black male patients disappeared from the healthcare system entirely. They didn’t trust it. And they weren’t coming back.
So we went to them. Churches, barbershops, community halls. We partnered with local Black leaders and physicians. We brought vaccines and information directly to them, on their terms. And it worked—because we showed up, and we listened.
But now, outside of crisis, we’re back to asking patients to come to us. And some simply won’t. Because fear still speaks louder than our good intentions.
There are patients I still lose sleep over. He’s one of them. Not because I failed him medically, but because I couldn’t reach him emotionally.
And I keep wondering: What more could I have done? Would a Black physician have succeeded where I couldn’t? Did he see me as part of the system that hurt him—or the one trying to save him?
Until we truly address the roots of mistrust, the disparities will persist. Until we earn back the right to care for every patient—especially the ones most at risk—these stories will continue to repeat.
He never came back.
And I fear he never will.
Call to Action:
It’s time for more than awareness. It’s time for action.
We need targeted outreach, culturally competent care, and health systems designed to earn trust—not demand it. That means:
- Increasing recruitment and retention of Black physicians, particularly in primary care and urology
- Funding community-based health programs that meet patients where they are
- Offering flexible scheduling and mobile screening options for high-risk, underserved populations
- Training providers in trauma-informed, culturally sensitive communication
- And listening—really listening—to what our patients need to feel safe.
The cost of silence is too high. So let’s not let fear win again.
Finding My Rhythm: Healing, Leading, Becoming 
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