Why clinicians in acute hospitals may fail to engage in direct communication with people with intellectual disability.

This case highlights the healthcare inequities faced by people with intellectual disability, including diagnostic overshadowing, communication barriers, and the need for personalised, meaningful adjustments in care. A woman in her fifties with mild intellectual disability, epilepsy, and diabetes insipidus experienced delayed diagnosis and treatment because healthcare providers assumed she could not tolerate magnetic resonance imaging; however, when the scan was eventually completed with supported communication, it revealed a serious brain tumour with metastases. The case shows that diagnostic overshadowing can arise not only from misattributing symptoms, but also from untested assumptions about a patient's ability to engage with diagnostic procedures. It also underscores the importance of involving patients and families directly in healthcare decisions to support autonomy and prevent avoidable harm. Addressing these systemic issues is essential to deliver equitable, patient-centred care in acute hospital settings.