Your Patient Is in Pain. Hear Their Cry.

The recent heartbreaking story of 18-year-old Nevaeh Crain, a Texas woman who died after she was denied critical care amid complications in her pregnancy, underscores the grave consequences of restrictive abortion laws in Texas and other states. Crain initially sought care at two separate emergency departments: at the first they diagnosed her with strep throat but didn’t investigate her cramps; at the second she screened positive for sepsis and was told her fetus still had a heartbeat. Despite her repeated accounts of pain and distress, she was sent home from both facilities. By the time the third hospital investigated whether she had fetal demise, it was too late for both mother and baby.

This story and so many like it across the country highlight a troubling reality that many patients routinely face: when healthcare providers dismiss their pain and discomfort. While Crain’s case faced the added complexity of restrictive abortion laws, the overarching lesson about listening to patients still stands.

The fact that some patients’ healthcare claims are disregarded or minimized by providers is an injustice that clinicians, healthcare administrators, policymakers, and advocates need to address.

In a recent study, researchers demonstrated that women were significantly less likely than men to have healthcare providers take their pain seriously and appropriately when they were treated in emergency departments. And when researchers presented providers with hypothetical clinical scenarios of patients in pain, they considered women’s pain to be “less intense” than men’s.

Though troubling, such findings are consistent with other research that demonstrates the health and medical concerns of some groups are simply not treated with the same level of import, urgency, or respect as others. These differences tend to occur along all-too-familiar axes of gender, race, and their intersection.

For example, in a recent report on Black women’s experiences in healthcare, they were more likely than all other groups to report being treated unfairly or with disrespect due to their race. Over 20% reported a discriminatory experience, compared to 13% of Black men.

As a public health researcher and professor with over 15 years of experience, I frequently discuss these issues with students, focusing on the role of implicit biases — those prejudices that operate subconsciously — in shaping healthcare interactions.

Implicit biases can negatively impact the quality and timeliness of care, ultimately leading to poorer health outcomes for patients from historically marginalized groups. While it is the case that all individuals hold biases, when these biases influence life-and-death decisions in healthcare, they can become dangerous.

In one first-of-its-kind study from 2007, researchers demonstrated the influence of implicit racial biases on physicians’ treatment decisions related to heart attacks. The results showed that physicians with higher levels of racial implicit bias were less likely to recommend potentially life-saving treatment for Black patients compared to white patients.

Yet, framing inequitable treatment solely in terms of individual biases falls short. It oversimplifies a complex issue, reducing it to interpersonal dynamics and placing the “blame” on individual healthcare providers.

This focus risks ignoring the larger systemic forces that enable and reinforce these biases. And it doesn’t answer crucial questions about why some people’s health concerns are given more attention than others or why some individuals are considered inherently more “believable” than others in healthcare settings.

To understand the roots of these biases, it is helpful to look at the concept of epistemic injustice, a term coined by British philosopher Miranda Fricker. Epistemic injustice goes beyond individual bias and seeks consideration of how systems of power and privilege shape who is regarded as a “knower” and whose experiences are valued as credible.

Epistemic injustice arises when individuals or groups are denied recognition as credible witnesses to their own experiences. In healthcare, this manifests when providers see certain patients — often women, people of color, or those living in poverty — as inherently less trustworthy or competent to speak about their health and deny patients their rightful place as valid sources of knowledge about their own bodies and health.

To be sure, there is a great deal of training and specialized knowledge that nurses, doctors, and other healthcare professionals possess. There will almost always be a power differential between providers and patients. This reality, in and of itself, does not automatically lead to injustices, however.

So, it is necessary to work toward a more epistemically just healthcare system, one in which biases about who is “believable” are less likely to take root. A critical step forward is embracing person- or patient-centered care and shared decision-making as foundational approaches in healthcare.

Shared decision-making requires patients to be active participants in discussions about their care. For this to happen, providers must be willing to listen — to truly listen — to their patients and trust them as collaborators in the process of diagnosis and treatment. Building this trust is not a simple task, but it is essential to dismantle the systems of epistemic injustice that deny marginalized groups the right to be seen and heard in healthcare settings.

Ultimately, moving toward epistemic justice in healthcare isn’t just about making providers aware of their biases. It’s about transforming the healthcare system to recognize and respect patients’ knowledge and experiences, particularly those from communities that have historically been dismissed.

If this country is to have a healthcare system that treats all patients equitably, it is essential to address these structural injustices head-on. Doing so requires a shift from focusing solely on individual bias to examining and dismantling the broader frameworks of power that shape perceptions of who is credible and deserving of care.

Wendy Bostwick, PhD, MPH, is an associate professor of Population Health Nursing Science at the University of Illinois Chicago and a Public Voices fellow with The OpEd Project.

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