Gaslight, Gatekeep, Girl Boss: Epistemic Injustice, Communication Failures and Barriers of Access to Gynaecology Care

Abstract

Clinical epistemic injustice occurs when a healthcare professional prejudicially discredits a person’s knowledge or lived experience, resulting in epistemic harm. People seeking gynaecological care are particularly at risk of experiencing compound epistemic harms as gynaecology consultations are the site of complex, sensitive and time-constrained communication interactions. Epistemic harm impacts healthcare by increasing missed diagnosis, disease burden and morbidity, and reducing trust. Gynaecological care in Aotearoa New Zealand is socio-politically situated in a marginal position within medical hierarchies, reflected in comparatively limited access to specialised resources and increased rates of declined referrals to secondary services. For care-seekers, systemic constraints intertwine with poor health communication and routinized dismissal of experiential knowledge in clinical consultations. This work investigates 74 narrative experiences of epistemic (in)justice in gynaecological care in Aotearoa New Zealand. Thematic analysis revealed three major themes: gaslighting, gatekeeping and epistemic derailing (or, employing gendered symptom normalization to supplant a care-seeking request and ultimately dismiss it) from narratives. Encouragingly, the themes of active resistance and power negotiation were also identified, highlighting people’s proactive attempts to overcome barriers. In consideration of communicability-based barriers to access care, developing a shared understanding and common language around epistemic (in)justice may offer a pathway to articulate such experiences and implement guidance to promote justice-based communication within gynaecological care spaces.