In healthcare, communication is more than just exchanging words—it’s a matter of life and death. Patients depend on their healthcare providers to listen, believe, and act on their experiences. But for many, this basic expectation is undermined by testimonial injustice, where biases against someone’s identity unfairly diminish their credibility. The result? Misdiagnoses, delayed treatments, and, often, lasting harm.
Understanding and addressing testimonial injustice is essential to improving patient safety and ensuring that healthcare systems serve everyone equally.

What Is Testimonial Injustice?
Testimonial injustice, a term coined by British philosopher Miranda Fricker, occurs when prejudice causes someone’s knowledge or testimony to be unfairly dismissed. In healthcare, this happens when patients—especially those from marginalized groups—are not believed or taken seriously by their providers.
Consider a woman seeking help for chronic pain. Her provider might dismiss her complaints as “stress-related” rather than investigating further, influenced by gender biases. Or imagine an African-descendant patient whose pain is underestimated because of stereotypes about higher pain tolerance. Now, envision being both and being dismissed when you complain about your painkiller effectiveness despite being a doctor in pharmaceutical science: welcome to my invisible patient experience.

These examples are not just shocking—they’re devastating. They reflect a long history of harm, rooted in a medical system that once codified scientific racism and eugenics, establishing non-disabled privileged White European male traits as the human ideal. It was magical thinking, not science. While medical science began acknowledging and addressing some of the harmful effects of then-purposed medicine in the 1970s, humanity’s journey toward equity, recovery from this toxic legacy, and authentic, universal, objective, and critical science is far from over.

How Does It Impact Healthcare and Patient Safety?
Testimonial injustice undermines patient care in profound ways:

Misdiagnoses and Delayed Diagnoses: When providers dismiss patient accounts, they risk overlooking critical symptoms or making incorrect assumptions.
Ineffective or Harmful Treatments: Ignoring patient feedback about treatment side effects can prolong suffering or exacerbate conditions.
Mental Health Strain: Being dismissed repeatedly can leave patients feeling anxious, helpless, and even traumatized.
Erosion of Trust: Patients who feel unheard often avoid seeking care, further endangering their health.


Who Is Most Affected?
While testimonial injustice can happen to anyone, its impact is magnified for marginalized groups:

African descendants and the global majority: Stereotypes about pain tolerance and health behaviors often lead to their concerns being dismissed.
Women: Gender biases contribute to the widespread minimization of women’s pain and symptoms.
Individuals with disabilities: Their self-reports of symptoms or limitations are frequently doubted.
Individuals with low incomes: Economic prejudice may lead to their concerns being trivialized or misinterpreted as non-compliance.
Elderly patients: Ageism can result in their symptoms being dismissed as “just getting old.”


The Missing Piece in Healthcare Communication
A recent DutchNews article highlights how poor communication contributes to medical errors, drawing on a report by the Dutch Patiëntenfederatie. It points to issues like unclear protocols, understaffing, and inadequate collaboration.
While these factors are critical, the article overlooks a key dimension: testimonial injustice. Biases that devalue patient voices amplify the risks of communication failures, especially for marginalized groups. By framing communication breakdowns as purely logistical, such discussions miss the deeper inequities that fuel these errors.
A comprehensive approach must address both structural inefficiencies and the biases that shape how patient testimonies are received.

Solutions: A Collective Responsibility
Addressing testimonial injustice requires systemic change and a commitment from all sectors of society.
What Can Patients Do?

Document and Advocate: Keep detailed records of symptoms, treatments, and interactions with providers.
Seek Allies: Bring a trusted friend or family member to appointments to reinforce your voice.
Know Your Rights: Familiarize yourself with patient rights to ensure you’re treated fairly and with respect.

What Can Patient Organizations Do?

Amplify Patient Voices: Create platforms where patients can share their experiences to raise awareness and drive systemic change.
Educate and Empower: Provide resources, workshops, and advocacy tools to help patients navigate healthcare systems effectively.
Partner with Providers: Collaborate on training programs to address bias and implement patient-centered care models.
Advocate for Policy Change: Push for legislation enforcing equitable practices and transparent reporting mechanisms for patient complaints.

What Can Healthcare Professionals Do?

Train in Empathy and Bias Awareness: Education on implicit bias and cultural humility should be part of every medical curriculum.
Value Patient Narratives: Providers must actively listen and validate patient experiences as essential data for diagnosis and care.
Diversify the Workforce: Representation within healthcare teams can reduce systemic biases and foster trust.

What Can Healthcare Professional Organizations Do?

Set Standards for Bias-Free Care: Develop and enforce guidelines to promote equity in patient interactions.
Foster Lifelong Learning: Offer continuing education on empathy, cultural competence, and patient-centered care.
Track Equity Metrics: Monitor and publish disparities in patient outcomes to drive accountability.
Support Research: Fund studies exploring the causes and impacts of testimonial injustice in healthcare.

What Can the Pharmaceutical Industry Do?

Conduct Inclusive Research: Design clinical trials that reflect the diversity of patient populations.
Engage Communities: Work with diverse groups to develop accessible and culturally appropriate treatments.

What Can Policymakers Do?

Strengthen Oversight: Enforce policies that hold institutions accountable for addressing inequities.
Support Advocacy: Fund initiatives amplifying marginalized voices in healthcare.

What Can Academia Do?

Decolonize Curricula: Integrate perspectives from historically marginalized communities into medical and healthcare education.
Engage Communities: Co-create research with patients to ensure it reflects real-world experiences.

What Can the Media Do?

Amplify Marginalized Voices: Highlight patient stories to shine a light on testimonial injustice.
Challenge Stereotypes: Avoid perpetuating biases in health and science reporting.
Promote Solutions: Cover success stories of equity-driven healthcare reforms.

What Can the Public Do?

Educate Themselves: Learn about biases in healthcare and support advocacy efforts.
Advocate for Change: Pressure policymakers and institutions to prioritize equity.
Support Ethical Media: Follow and share outlets that amplify diverse perspectives.


Conclusion
Testimonial injustice is a silent but pervasive threat in healthcare, compromising patient safety and deepening inequities. Addressing it requires recognizing the biases that shape patient-provider interactions and taking collective action to dismantle them.
Articles like the one from DutchNews.nl are crucial in highlighting communication challenges but must expand their scope to include how inequities compound these issues. A truly effective healthcare system listens to and values every voice, ensuring all patients receive the care and dignity they deserve. Together, we can create a healthcare system where everyone’s story matters.

What can you commit to do?