Epistemic injustice in healthcare: How doctor gender and speciality shape patient voice in women's thyroid care.

Women's health concerns are frequently dismissed in clinical settings, a pattern described as medical gaslighting. Drawing on Fricker's (2007) framework of epistemic injustice and Carel and Kidd's (2014) extension to healthcare, this study conceptualises patient voice, encompassing feelings of involvement, empowerment, and being heard, as a measurable correlate of epistemic injustice in the clinical encounter. We distinguish two forms: testimonial injustice, where a patient's symptom account is assigned insufficient credibility, and hermeneutical injustice, where gaps in interpretive frameworks render a patient's experience medically unrecognisable, for example, when thyroid symptoms are dismissed as psychosomatic or non-specific. We hypothesise that primary care is structurally prone to both forms, while specialist care reduces hermeneutical injustice through deeper interpretive resources; residual testimonial injustice in specialist settings is further shaped by doctor gender. These hypotheses are tested using data from a UK-wide survey of 898 female thyroid patients. Thyroid conditions disproportionately affect women and involve prolonged diagnostic delays, providing a critical empirical context. Patients diagnosed by consultants report significantly higher patient voice than those diagnosed by GPs; female consultants generate stronger effects than male consultants; and no gender difference is found among GPs, consistent with hermeneutical injustice operating as a structural, gender-independent feature of primary care. While testimonial and hermeneutical injustice cannot be empirically separated with these data, the pattern of results aligns with theoretical predictions. The study contributes to debates on epistemic injustice, gender, and healthcare equity, with implications for GP training, specialist referral practice, and patient-centred care policy.