Medical Mistrust: The Social Determinant of Health We Ignore

What if the biggest driver of poor health isn't just housing, food, or income – but mistrust? In this episode, host Judson Howe sits down with Dr. Katherine Gergen Barnett (KGB) – family physician, health policy leader, and community-based researcher at Boston Medical Center – to unpack medical mistrust as a social determinant of health and what it really takes to rebuild trust in the exam room and beyond. Drawing on two decades in primary care, Dr. Gergen Barnett shares how: • Mistrust quietly shapes who shows up, what they share, and whether they follow medical advice – even when they have insurance. • Primary care and family medicine can act as the "engine" for equity, better outcomes, and lower mortality. • Staying curious ("What matters to you?") changes the dynamic from fixing problems to honoring people's lives. • Community voice, patient advocates, and community-based participatory research can transform clinical trials and policy from the ground up. • Transparent quality data and paying for trust (not just RVUs) could radically reorient our system. Along the way, KGB reflects on her journey from Yale to family medicine, why elite institutions still lack FM residencies, and how financial incentives and policy decisions are either eroding or rebuilding trust every day. If you care about trust, equity, and the future of primary care, this conversation will challenge how you think about "good medicine" – and who gets to define it.   Thank you to www.everydayboston.org for providing footage of Dr. Barnette used in our trailer.