Multiple studies over an extended period of time confirm what most clinicians already knew: African Americans are generally not as trusting of medical clinicians as other racial groups. What many of us did not know was why. This second chapter revisits the predominant atrocities visited upon African Americans and their impact on clinical interactions, as well as the fundamentals of the patient encounter, but spends a significant amount of time on “trust.” Almost half of all African Americans (44%) distrust healthcare providers and the American healthcare system, regardless of the provider’s ethnicity. This is in sharp contrast to most other Americans. Some of the reasons for distrust are reviewed, and strategies to build trust are outlined. African American patients are also generally on guard for biases, whether conscious or unconscious. More formally known as explicit and implicit biases, researchers have looked at the impact bias can have on the quality of patient encounters. Finally, showing competence in clinical care is a simple yet undeniable aspect of assuming the care of African American patients.