Based on interviews with patients, she identified the causes of these ‘gaps’ being the ‘coldness’ associated with impersonal diagnostic procedures, doctors’ perceived indifference to or ignorance of the concerns of their patients, and a disorientating use of medical jargon. Korsch published an influential series of papers identifying ‘gaps in doctor‐patient communication’. In the late 1960s and early 1970s, paediatrician Barbara M. An abundant body of empirical evidence indicates that the epistemic complaints described are not anomalous but rather indicators of serious and persistent problems that arguably arise from contingent structural features of contemporary healthcare practice, but which could be addressed through systematic reform. The second feature of these epistemic complaints is that they are systematic and longstanding features of healthcare systems, rather than isolated or incidental cases of communicative failure in otherwise epistemically harmonious systems. Moreover such breakdowns in the epistemic relationship can result in ill persons having negative subjective experiences of healthcare, such that they might come to associate hospitals not only with sickness and suffering, but also with confusion and isolation. The practical consequences of such behaviours can include the jeopardising of the ill person's treatment and significant costs for the healthcare system when important information is overlooked. Such breakdowns in relationship have a range of practical consequences, including the unwillingness or inability of ill persons to give complete or accurate reports of their symptoms and adherence to treatment, which in turn can create a need for additional tests or further referral. The first is that they tend to have the consequence of complicating – and, in certain cases, compromising – the epistemic relationship between ill persons and the healthcare professionals charged with their care. Two features of these epistemic complaints are worth noting. Taken together, a difficult epistemic situation emerges in which neither group can engage in effective testimonial and hermeneutical relations with the other. They often complain that patients provide medically irrelevant information, make odd statements and superfluous remarks about their condition, or otherwise fail to contribute epistemically to the collection of medical data. The second are physician complaints, understood broadly as those offered by healthcare professionals. These typically take the form of reports that healthcare professionals do not listen to their concerns, or that their reportage about their medical condition is ignored or marginalized, or that they encounter substantive difficulties in their efforts to make themselves understood to the persons charged with their diagnosis and treatment. The first are what one might call patient complaints, those made by ill persons and especially by those with prolonged and involved experience of modern healthcare, such as the chronically ill. ![]() Two broad forms of epistemic complaints reliably arise within contemporary healthcare practice. We note, however, that the issue described here may be prevalent elsewhere and intersect with additional problems existing in other healthcare systems. We focus on this type of healthcare in order to avoid making generalisations about other types of healthcare and in order to describe the problem in its simpler form. We thus propose, in this article, to examine epistemic injustice within healthcare in the developed world. 2 We suggest that this finding is characteristic of a certain epistemic stance that tacitly incorporates presumptions about the capacities of patients to provide relevant information in healthcare contexts, and which is both epistemically unjustified and epistemically unjust. The authors concluded that this premature interruption of patients resulted in a loss of relevant information. Of seventy‐four office visits recorded, only in seventeen (23%) was the patient allowed to complete his or her opening statement of concerns. A study published in 1984 found that the average amount of time between a patient beginning to speak and the doctor's first interruption was eighteen seconds.
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