Racial Concordance and the Assumption of Trust: Why Engagement Is Often Mistaken for Partnership in the Care of Black Men

Race concordance between patients and clinicians is frequently promoted as a strategy to improve trust and engagement for Black men in healthcare. Evidence suggests that encounters with Black male clinicians often increase patient comfort and observable engagement; however, engagement alone does not necessarily reflect trust. Drawing on professional experience as a nurse and researcher working with Black men, and on prior research examining shared decision-making preferences among Black men with hypertension in the U.S. Mid-South, this Personal Narrative examines how race-concordant encounters may rely on presumed trust, leading clinicians to advance diagnosis and treatment planning without adequate co-construction of care. When engagement is conflated with trust, Black men may appear receptive while remaining insufficiently involved in clinical decision-making. Recent evidence further suggests that high-quality shared decision-making (SDM) is independently associated with reduced healthcare expenditures, and that these effects are amplified within racially concordant relationships, findings that underscore the imperative to move beyond surface-level engagement. This article argues that trust must be deliberately cultivated through practices that assess patient knowledge, elicit preferences, and support shared decision-making. Evidence-informed recommendations are presented to support clinicians and healthcare leaders in strengthening patient-clinician partnerships and advancing equitable patient experience for Black men.