Not too long ago, a man in his forties came to see me. His chief complaint was that he felt tired.

And not just any kind of tired—the kind of tired that makes people finally schedule a doctor's appointment after spending years avoiding them.

As we talked, he admitted something I hear surprisingly often.

“No offense, but..I don’t like doctors.”

Coincidentally, over the course of my career, I’ve had the privilege of caring for quite a large number of people who don’t trust doctors. As someone who has primarily worked in safety net clinics, I have spent a disproportionate amount of my career serving people with high barriers to care including people with Medicaid, who are underinsured or who have no insurance at all. Those are the folks our system is the cruelist to — so I’m quite used to working with people who don’t trust the institution of Healthcare broadly, and doctors specifically.

I’ve spent a lot of time thinking about people like this.

Whenever I hear someone speak of their mistrust of doctors and healthcare, my heart always breaks a little in the moment. That’s because I instantly know I’m sitting across from someone who has been directly hurt by our healthcare system in some way.

Maybe they felt dismissed. Maybe they spent years looking for answers. Maybe they were misdiagnosed, ignored, or simply worn down by a system that made them feel like nobody was listening.

Whatever the reason, I know I’m usually dealing with someone carrying a degree of institutional trauma.

It colors how I approach them.

I gave him the reply I often do:

“Neither do I,” I told him.

It was probably a little too honest.

He laughed.

There was more truth in that answer than I probably intended, and I suspect he could tell.

We moved on.

We reviewed his symptoms, lifestyle habits and lab work.

As we did, he had questions.

A LOT of questions.

Good questions.

He was asking me the kind of questions that tell you someone has dedicated a significant amount of time trying to understand what is happening inside their own body.

His testosterone level was low.

That part wasn’t particularly surprising. Low testosterone can cause fatigue, decreased exercise tolerance, low libido, and a host of other problems.

But his questions weren’t just about whether his testosterone was low, but about why it was low. He wanted to understand how the various hormones fit together, why one marker mattered more than another, and what patterns we should be looking for.

As our conversation continued, he began walking me through his own interpretation of the results. His reasoning was logical. He had taught himself enough endocrinology to have a thoughtful conversation about the feedback loops that regulate the male hormonal system.

These weren’t exactly the kinds of questions I typically hear from patients (although I expect to have more conversations at this level as patients continue to utilize AI to understand their results).

These were the kinds of questions I would expect from a medical student trying to understand physiology.

I remember thinking how remarkable it was that someone with no formal medical training had developed such a sophisticated understanding of male hormone physiology.

I’ve thought about that encounter many times since then; not just because my patient was unusually intelligent (although he certainly was). I’ve kept thinking about it because somewhere along the way, a man who had spent years avoiding doctors had also taught himself enough endocrinology to have a conversation that many first-year medical students would have struggled to navigate.

That realization has stayed with me.

Because the more I reflected on it, the less I found myself asking, “How did he learn all of this?”

Instead, I kept asking a different question.

Why did he have to?

How Did We Get Here?

There was a time when patients weren’t expected to understand endocrine physiology, immunology, or the difference between primary and secondary hormone deficiencies.

The relationship between doctors and patients rested on a relatively simple bargain: patients brought their symptoms, and physicians brought their expertise. Patients weren’t expected to know how hormones interacted, which laboratory markers mattered most, or what questions they should be asking. They simply described how they felt and trusted that someone else would connect the dots.

That bargain has quietly changed.

Today’s patients increasingly arrive having read journal articles, listened to podcasts, joined disease-specific online communities, tracked years of laboratory results, and developed thoughtful questions about diagnoses they had never heard of before becoming sick. They know the names of medications they have never taken, understand laboratory values that once would have seemed incomprehensible, and often have a working knowledge of their disease that would have been extraordinary a generation ago.

It is tempting to dismiss this phenomenon as “Dr. Google.” In fact, many physicians do. The assumption is that patients have become overconfident simply because information is now more accessible than ever before.

I think that explanation is an excuse that misses something much bigger.

The internet did not create the expert patient. It simply gave patients access to information they were already searching for.

The more interesting question is why so many people felt compelled to start searching in the first place.

People rarely spend hundreds of hours teaching themselves endocrinology because they find hormones fascinating. They do it because they still don’t understand why they feel terrible. They do it after another appointment that raises more questions than answers, while waiting months to see a specialist, or after being told that everything looks “normal” despite knowing something is still wrong.

Uncertainty is one of the hardest things for human beings to tolerate. When medicine cannot immediately provide answers, patients naturally begin looking for them elsewhere.

It’s not because they aspire to become doctors, but because understanding offers something illness often takes away: a sense of agency.

In that sense, the rise of the expert patient is not primarily a story about curiosity. It is a story about adaptation.

Patients adapted to a healthcare system that increasingly requires them to.

Expertise as a Survival Strategy

Once you begin looking for it, you start seeing this pattern everywhere.

I see it in women with endometriosis who can explain the strengths and limitations of different hormonal therapies before they’ve ever met a gynecologist who specializes in the disease. I see it in patients with autoimmune conditions who understand the nuances of inflammatory markers and biologic medications because they have spent years trying to make sense of symptoms that never fit neatly into a single specialty. I see it in parents of children with complex medical needs who can recite medication doses, laboratory trends, and specialist recommendations from memory because doing so has become essential to keeping their child healthy.

Perhaps nowhere has this been more visible than in the Long COVID community.

Millions of people developed a condition that medicine was only beginning to understand. They found themselves experiencing debilitating fatigue, cognitive dysfunction, exercise intolerance, autonomic symptoms, and dozens of other manifestations that often defied existing diagnostic frameworks. Faced with uncertainty, many did what human beings have always done when institutions could not provide answers quickly enough: they organized. They formed online communities, compared experiences, tracked symptoms, shared emerging research, identified patterns, and, in many cases, generated hypotheses that researchers would later go on to investigate formally.

From the outside, it looked like patients doing their own research.

From the inside, it looked like survival.

We often celebrate these patients as empowered, engaged, or exceptionally informed. While those descriptions are true, they risk obscuring a more uncomfortable reality. Expertise is rarely the starting point of their story. More often, it is the endpoint of a long period of uncertainty, dismissal, unanswered questions, and the growing realization that if they wanted to understand what was happening to their bodies, they would have to become active participants in producing that understanding.

In other words, expertise became a survival strategy.

Understanding that distinction matters because it changes how we interpret the rise of the expert patient. If patients are becoming increasingly knowledgeable simply because information is easier to access, then this is primarily a story about technology. But if patients are becoming experts because the healthcare system increasingly depends on them to fill gaps in diagnosis, coordination, and knowledge, then this is a story about institutions.

And that is a very different story.

When Empowerment Becomes Expectation

We rarely celebrate people for becoming experts in systems they never wanted to understand.

We don’t praise someone for memorizing insurance law after a denied claim or mastering disability regulations after losing the ability to work. We recognize that kind of expertise for what it is: knowledge acquired under pressure, not by choice.

And yet, when it comes to healthcare, we often tell a different story.

We celebrate patients for becoming informed, engaged, and empowered. We admire the woman who has read every paper on endometriosis. We applaud the parent who can explain the genetics of their child’s rare disease better than most clinicians. We marvel at the patient who arrives with a binder full of laboratory results and a sophisticated understanding of their condition.

There is something genuinely admirable about all of those things.

But we tend to celebrate adaptation without asking what made adaptation necessary in the first place.

Patients have adapted remarkably well.

The more uncomfortable question is why they had to.

That question changes the way we think about patient empowerment.

Knowledge has always been one of medicine’s greatest tools.

I want patients to ask questions. I want them to understand their diagnoses, participate in decisions, and advocate for themselves. The goal of this essay is not to argue for a return to the days when patients were expected to sit quietly and accept whatever they were told.

Rather, I think we have quietly crossed an important line.

There is a profound difference between empowering patients with knowledge and expecting them to acquire it in order to receive good care.

Empowerment is a choice.

Expectation is an obligation.

When understanding your illness becomes a prerequisite for navigating the healthcare system, expertise is no longer simply empowering. It becomes another form of labor.

In last week’s essay, I argued that healthcare increasingly shifts administrative work onto patients. Patients schedule appointments, coordinate between specialists, chase down medical records, battle insurance companies, and manage an ever-growing list of logistical tasks that were once handled by institutions themselves.

This, I believe, is the next chapter of that story.

Healthcare has not only shifted administrative labor onto patients. It has increasingly shifted intellectual labor onto them as well.

Patients are expected to understand laboratory results, recognize patterns across seemingly unrelated symptoms, reconcile conflicting medical opinions, keep up with emerging research, and arrive at appointments knowing not only what questions to ask, but often which diagnoses to consider.

For some patients, that expectation is manageable.

For many others, it is not.

The irony is that the people expected to shoulder this burden are often the least equipped to carry it. The patient with severe depression may struggle to complete everyday tasks, let alone spend hours reading medical literature. Someone living with Long COVID may experience such profound brain fog that concentrating on a single article is exhausting. A single parent working two jobs may have neither the time nor the energy to become an expert in autoimmune disease. And patients with limited health literacy and fewer financial resources begin the race several steps behind.

In theory, every patient has access to the same information.

In practice, not every patient has the same capacity to transform that information into expertise.

That distinction is important.

When a healthcare system increasingly depends upon expert patients, it inevitably advantages those who have the greatest capacity to become them.

Everyone else falls further behind.

This is why I don’t see the rise of the expert patient as merely a fascinating cultural shift or a triumph of information technology—

I see it as a warning.

We often celebrate adaptation without asking what made adaptation necessary in the first place. We marvel at patients who have become experts in diseases they never wanted to learn about, but rarely stop to ask what it says about our institutions when acquiring that expertise begins to feel less like a choice and more like a prerequisite for receiving good care.

Whenever institutions quietly transfer their responsibilities onto individuals, the responsibility itself doesn’t disappear.

It simply changes shoulders.

If This Essay Resonated

I spend these essays examining the systems that shape our health.

In my clinical practice, I help people navigate them.

Many people believe they have to choose between conventional medicine and a more holistic approach. I don’t.

As an integrative medicine physician, I combine evidence-based conventional care with deep history taking, nutrition, lifestyle medicine, and carefully selected functional testing to understand you as a whole person—not just a diagnosis.

At my Chicago-based practice, Twin Village Health, I work with adults experiencing chronic symptoms that often don’t fit neatly into a 15-minute visit, including fatigue, hormone concerns, digestive disorders, metabolic dysfunction, autoimmune disease, and mental health conditions.

If you’re looking for a physician who takes both the science and your lived experience seriously, I’d love to meet you.

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The Post That Hit a Nerve

A few weeks ago, I posted a short note on Substack:

Of all the things I've written so far, I wasn't expecting that one to resonate the way it did.

Thousands of people liked it and hundreds shared it. The comments came fast, and they kept coming.

The responses were strikingly similar, and were eerily reminiscent of what patients have told me since I started practicing. Consistently, pateints have spoke of:

• insurance battles that dragged on for months and sometimes years

• appointments that took six different phone calls to schedule

• Referral that evaporated somewhere between one office and another

• Prior authorizations that were denied, then appealed…then denied again

• Medications that went unfilled because neither the pharmacy nor the patient could get the doctor to respond to a refill request

• Disability paperwork that requires the stamina of a healthy person to prove you weren’t one

• Portal messages seemingly sent into the literal void

One comment really stopped me:

This one captures something that has bothered me for years.

Patients are now expected to arrive pre-diagnosed, pre-researched and pre'-organized. They are being asked to do the intellectual work of medicine before they ever reach a clinician, and the administrative work of medicine after they leave.

All of that raises the question I want to explore in this essay:

Why does getting healthcare increasingly feel like work?

The Hidden Labor of Being Sick

I’ve spent over a decade in primary care. In that time, I have written thousands of orders—for referrals, imaging, labs, medications, medical equipment and follow-up appointments among so many other things.

For most of my career, I’ve considered each of these clinical decisions.

Now I view them differently: I view them as assignments.

When I order an MRI, I am assigning homework. A patient trying to get an MRI has to find a facility in network, get there, and then personally chase down the imaging results afterward because the imaging center’s computer system and their PCP’s computer system don’t talk.

When I refer a patient to Rheumatology, I am assigning homework — one that involves a patient calling to find out whether the referral ever actually arrived, repeating her medication list on a fourth intake form, and sitting on hold during the only lunch break she gets.

When I say “let’s recheck labs in six weeks”, I am assuming she has transportation, a flexible employer, and a phlebotomy lab open at an hour she is not working.

Modern medicine measures the burden of disease. It rarely measures the burden of obtaining care.

We have validated instruments for pain, fatigue, and depression — scales, scores, severity indices—everything. These are important.

On the other hand, we have no instrument to capture:

• total hours on hold

• vacation hours spent sitting in a clinic for hours

• number of insurance appeal letters written

• duplicate paperwork completed

—Not to mention the cognitive load of keeping a fragmented system from forgetting about you entirely.

Diseases get measured. The labor of being a patient does not.

And if there’s one thing I know about medicine it’s this: what medicine doesn’t measure, medicine does not see.

So the work lands invisibly (and entirely) on the patient or caregiver.

And in effect, the modern patient is functioning as: 1) a healthcare administrator, 2) a project manager, 3) an advocate, 4) a researcher, and 5) a care coordinator — for an organization of one, with no staff, no training, and no sick days from the job of being sick.

For years, I thought I was just doing my job—practicing medicine. I didn’t fully appreciate how often I was also assigning work.

And what it was costing patients.

The Cruel Paradox

One particularly cruel aspect of Healthcare’s design is this:

Think about what the type of labor I’ve described actually requires:

• Energy

• Working memory

• Executive function

• Sustained concentration

• Reliable transportation

• Time during business hours

• The confidence to argue with an insurance company

• The ability to keep track of appointments, medications, portals, passwords, referrals, and paperwork.

• The emotional resilience to encounter the same obstacle over and over without giving up.

In other words, it requires many of the very capacities that illness itself often takes away.

Now consider who the heaviest users of healthcare actually are.

This list includes, for example, people with Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or Long COVID, whose defining symptoms include crushing fatigue and cognitive fog. It includes people with chronic pain, which erodes concentration. People with depression, which destroys initiative. People with ADHD, for whom a multi-step referral process is a maze with no map. People with autoimmune disease, with cancer, with disabilities that the built environment already taxes daily.

Ironically, the conditions that bring people into the system are frequently the same conditions that impair the exact capacities the system assumes.

A patient with brain fog is asked to remember which of her three portals holds the lab order. A patient in a depressive episode is asked to initiate, organize, and follow through on a referral cascade. A patient exhausted by chemotherapy is asked to dispute a billing error across three phone trees.

It is a cruel paradox that the sicker people become, the more work the Healthcare system often asks them to do.

This is the inverse of how any humane system would be designed. And it is the part of the patient experience that we, inside medicine, are most prone to miss — because we encounter patients at the visit, not in the hours of administrative labor surrounding it.

When System Failure Becomes Patient Failure

Which brings me to a word I have come to distrust: “non-compliance”.

I’m not proud to admit that I have written it in medical charts at one point in my career. I was trained to. Most doctors were,

“Patient non-compliant with medications.”

“Noncompliant with follow-up.”

The term itself comes from a hierarchical relationship. Because, think about it —we don’t usually say a physician is “non-compliant” with a patient’s goals.

The word flows in one direction.

And it reveals an old assumption embedded in medicine: that when a treatment plan fails, the problem is often located in the patient rather than in the barriers surrounding them.

“Noncompliant” is a tidy word. It closes the loop. It keeps the rest of the system off the official record.

But we can see what gets charted and what doesn’t. The missed appointment is documented but not that the bus route to the clinic was cut. The unfilled prescription is charted but not the $87 copay in a week when rent was due. The incomplete referral is documented but the fact the specialist’s office called once, during the patient’s work hours, and never called back, wasn’t.

Medicine is meticulous about outcomes —and largely silent about obstacles.

Most patients are not refusing care. They are navigating barriers.

A missed appointment may look like noncompliance in the chart. In real life, it may be a lost referral, a missed bus, a caregiving conflict, a work schedule, an insurance denial, or simple exhaustion.

The problem is not that patients lack responsibility. It is that healthcare routinely misunderstands what it is asking of people.

How Did We End Up Here?

One reason this burden feels so overwhelming is that it did not arrive all at once.

Instead, it accumulated. Over time, Healthcare has become more and more specialized, fragmented and bureaucratic. It is more dependent on insurance approvals, referrals, documentation requirements, and regulatory processes than in previous generations.

None of these changes happened because someone set out to make life harder for patients.

Many were introduced for legitimate reasons: to improve quality, control costs, reduce fraud, coordinate care, or expand access to specialized expertise.

But, unfortunately, complexity has a way of creating work. And over time, much of that work has slowly but surely migrated to the patient.

As medicine became increasingly specialized, patients became responsible for connecting the pieces.

As insurance rules became more complex, patients became responsible for navigating them.

As healthcare organizations grew larger, patients increasingly became the coordinators between them.

Someone has to keep track of the referrals. Someone has to follow up on the test results. Someone has to notice when one specialist never received the records from another. Someone has to sit on hold with the insurance company.

Increasingly, that someone is the patient…or their caregiver.

In many ways, modern healthcare asks patients to perform the work of integration in a system that has become increasingly fragmented. In doing so, the result is a strange contradiction:

Healthcare has become more technologically advanced than at any point in human history; yet many patients spend a surprising amount of time acting as the go-between for institutions that are supposed to be caring for them.

If all of this sounds familiar, it is because these experiences are not isolated frustrations. They are symptoms of a larger design problem.

And over time, the responsibility for holding together an increasingly complex system quietly shifted onto the people least equipped to carry it.

What Would Patient-Centered Care Actually Look Like?

Perhaps that is why so many people responded to that Substack note.

Underneath the specific stories, so so many comments carried some version of the same quiet conclusion:

I thought I was disorganized.

I thought I was bad at this.

I thought it was my fault.

So let me say it plainly: patients are not failing healthcare. Healthcare has become unnecessarily difficult for the very people it is supposed to serve.

No one had to intend that outcome for it to be true — or for it to be worth fixing.

Which means "patient-centered care" — a phrase healthcare LOVES to throw around— has to mean more than it currently does. A truly patient-centered system would not just focus on delivering good medical care. It would focus on reducing the work required to receive it.

That would look like providers who actually coordinate with each other, so the patient doesn't have to be the messenger. Intake forms completed once, not four times. Fewer administrative hurdles between a doctor's recommendation and its execution. Real relief for caregivers. Technology designed to reduce patient labor rather than quietly shifting more of it onto patients. And as AI enters medicine, a simple test for every new tool: how much burden does it remove from sick people?

Because, at the end of the day, illness already demands so much. It takes people’s time, their energy, their attention and their money. Sometimes, it even takes their hope.

Healthcare should not add to that burden unnecessarily.

The goal of healthcare should not be to create patients who are better at navigating the system. The goal should be to build a system that requires less navigation in the first place.

Because people who are sick already have a job.

Getting better.

Thank you for Reading Health is Political

Dr. Brittani James is a Board-certified Family Medicine physician and co-founder of Twin Village Health, an Integrative medical practice in Chicago which provides physical and mental health care under one roof. She writes Health Is Political on the structural forces that shape who gets sick, who gets care, and who gets believed.

If this essay resonated with you, consider subscribing, sharing it with a friend, or joining the conversation in the comments.

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The “Rotterdam Criteria”

In May 2026, something unusual happened in medicine.

One of the most common disorders affecting women received a new name.

After a global consensus process involving 56 organizations and more than 14,000 participants, experts formally retired the term Polycystic Ovary Syndrome (PCOS) and replaced it with a new one: Polyendocrine Metabolic Ovarian Syndrome, or PMOS.

What struck me most was the reason: According to the group, the old name, “PCOS”, no longer reflected the science. For decades, physicians, researchers, and patients alike have been using a label that emphasized the ovaries and the appearance of “cysts” while obscuring what many experts now recognize as the central features of the condition: problems with metabolism, blood sugar regulation, hormones, and long-term health.

Medicine RARELY renames diseases.

So when it does, it’s worth asking…why?

For me, the answer begins in medical school.

Like most physicians of my generation, I learned PCOS through something called “The Rotterdam criteria”.

After ruling out other causes, a woman needed 2 of 3 findings to get a diagnosis:

1. Irregular ovulation, which often shows up as infrequent, unpredictable, or completely absent periods.

2. Hyperandrogenism, a medical term for excess male hormones that can lead to symptoms like unwanted facial hair, acne, or thinning hair on the scalp.

3. Polycystic ovaries, an ultrasound finding in which the ovaries contain an unusually large number of small immature follicles—structures often called “cysts,” (even though they are not actually cysts in the traditional sense).

That was the framework. That was the disease.

It was presented as a story about ovaries, irregular menstrual cycles and fertility impairment—and it is those things. But what I find striking now isn’t what the diagnostic criteria included —but what they left out.

There was no mention of insulin resistance, despite the fact that it is now understood to be one of the central drivers of the condition.

There was no mention of diabetes risk — despite women with PCOS facing nearly 3 times the odds of type 2 diabetes and close to 4 times the odds of pre-diabetes compared to women without the condition.

No mention of cardiovascular disease — despite a significantly elevated risk of coronary heart disease, measurable and documented, independent of body weight.

No mention of depression — up to 4 times higher odds.

No mention of anxiety — up to 5 times higher odds.

No mention of sleep apnea, which is elevated in women with PCOS regardless of BMI.

And there was certainly no mention of the profound and well-documented impact the condition has on a woman’s quality of life.

The Rotterdam criteria were not wrong—in fact, they were clinically useful.

But beyond that, they did something else, too: they taught a generation of physicians what to focus on when they treated at a woman with this condition. In other words, they trained clinical attention toward the reproductive aspects of the condition—almost exclusively.

And that is what had been bothering me.

The more women with PCOS I’ve cared for, the more I noticed a disconnect between the condition medicine taught me to recognize and the condition many women were actually living with.

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The Disease Women Were Actually Experiencing

The women who came to my practice with PCOS rarely led with fertility. Some did — infertility is a real and painful consequence of the condition for many — but most of them led with the struggles they were experiencing in their lives.

They described:

• Fatigue — a bone-deep fatigue that didn't always get better with sleep

• Weight gain that seemed to defy their diets and their efforts (and for many, unfortunately, the shame that followed)

• Intense cravings for carbohydrates and sugar that no one had ever connected to insulin resistance

• Irregular periods that sometimes disappeared for months and then returned without warning

• Hair where they didn’t want it and thinning where they did — hirsutism (the medical name for hair growth in women occurring in a male-like pattern such as on the lips or chin) and hair loss in the scalp

• Persistent acne that had been treated in isolation, without any clinician connecting it the endocrine disorder driving it

• Depression and anxiety that had been treated as separate problems with separate referrals

These women were not describing a condition of the ovary—they were describing a whole-body experience — biological, psychological, and social. Their lives were being shaped by a condition that medicine had came them a name for— and then, in many cases, not much else.

The diagnostic and management pathway many of them encountered reflected this narrowness. They were seen by their primary care provider or gynecologist for their irregular periods, were often prescribed oral contraceptives, and then sent on their way.

The increased cardiovascular risk was rarely discussed. Mental health was rarely integrated into the plan. When they returned with weight gain, they were told to lose weight. When they returned with depression, they were referred out. When they returned still struggling, they were sometimes told — implicitly or explicitly — that their problems were a matter of lifestyle.

Many of them had spent years being evaluated through a single lens: the reproductive lens.

Were they ovulating? Could they get pregnant? Was their cycle regular?

These were real questions—but not the whole question. And for many women, they were not even the most pressing question.

That disconnect raises an uncomfortable question: How did one of the most common endocrine disorders affecting women become defined primarily by its effects on reproduction?

What’s in a Name?

The rationale for the new name was explicit: the old one was a misnomer.

The term “polycystic” implied that the ovaries were filled with pathological cysts.

They are not.

The follicles that appear on ultrasound are arrested — small, multiple, immature — but they are not cysts in any conventional sense. Yet 47 percent of women with PCOS incorrectly believe that ovarian cysts are a key feature of their condition.

The name taught them the wrong thing about their own disease.

More fundamentally, the term “polycystic ovary syndrome” oriented attention toward the ovary — as though the ovary were the origin of the problem. The new name, PMOS, incorporates “polyendocrine” and “metabolic” because those are the systems actually in disarray: the hypothalamus, the pituitary, the adrenal glands, the pancreas, the insulin signaling pathways that run through nearly every organ.

The polycystic appearance of ovaries on ultrasound is, in the current understanding, a downstream manifestation — a consequence of the endocrine and metabolic dysfunction, not its cause. Yet for decades, it was in the name.

It was the name.

Names are not neutral. Names reveal what institutions think is important. They direct attention. They shape what gets funded, what gets taught, and what gets asked in the clinical encounter. The name "polycystic ovary syndrome" told clinicians where to look: the ovary. It told researchers what to study: the follicle. It told patients what was wrong with them: their ovaries.

But names don't emerge from nowhere. They reflect what the people who create them have been trained to see — and what they haven't.

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When Women’s Health Became Reproductive Health

To understand how PCOS came to be defined through a reproductive lens, it helps to understand that medicine was already routinely looking through that lens by the time two American obstetrician-gynecologists — Drs. Irving F. Stein Sr. and Michael L. Leventhal — published their landmark paper on the condition in 1935.

It was literally titled "Amenorrhea Associated with Bilateral Polycystic Ovaries."

They were seeing women who presented with absent periods and infertility—and their clinical work centered on restoring menstruation and fertility through surgery. Meanwhile, insulin had only recently been discovered—the concepts of insulin resistance and metabolic syndrome did not exist yet.

And so, their reproductive framing was not a failure of imagination—it was more a reflection of what medicine could see in 1935. The ovaries were visible. The infertility was obvious. The metabolic dysfunction, though, was harder to see.

And so the ovaries became the organizing feature of the syndrome, and the name followed.

The problem was not the name in 1935; the problem is that medicine kept using that reproductive framing long after the evidence demanded something different.

PCOS did not create the reproductive lens.

It inherited it.

In fact, the institutions that built modern women’s healthcare did not only fail to correct this—They deepened it.

When the World Health Organization (WHO) was founded in 1948, its constitution referenced women’s health only in the context of maternal health. When the Declaration of Alma-Ata was signed in 1978 — a landmark commitment to primary health care as a human right — it remained focused on women primarily as mothers, caregivers, and recipients of family planning services.

As one analysis of gender and global health later observed, women were historically regarded “of interest only in relation to their reproductive organs or their ability to adequately mother their offspring.”

This was not incidental—It was structurally embedded. And its consequences extended well beyond PCOS:

Cardiovascular disease is the leading cause of death among women in the United States — responsible for roughly one in three female deaths. For decades, it was studied almost exclusively in men. Women were underrepresented in clinical trials, their symptoms were measured against a male standard, and when they didn’t match — no crushing chest pain, just fatigue, nausea, a vague sense of something wrong — their heart attacks were misdiagnosed as gastrointestinal complaints or anxiety. The default cardiac patient in medicine was male. Women paid for that assumption with their lives.

Endometriosis affects roughly one in ten women. The average time from first symptoms to diagnosis is nearly ten years. In study after study, the delay traces back to the same source: women’s pain was normalized, minimized, or attributed to the ordinary discomforts of being female. Prior to diagnosis, 63% of women had their symptoms dismissed. Sixty percent reported that their physician did not validate their concerns when they sought treatment. A decade of suffering resulted, because medicine had been trained to expect women to endure reproductive pain without complaint.

PCOS is not an outlier. It is part of a pattern.

Until 1993, women of childbearing age were routinely excluded from clinical trials. The rationale was ostensibly one of safety — the risk of harm to a potential fetus. But the consequence was a medical knowledge base built almost entirely on male physiology.

A recent analysis of women’s health research at the NIH has documented how hard institutions have had to work in recent years simply to correct that omission. A 2022 study analyzing publications across six major women’s health journals found that 44% of all published topics were reproductive health — while cardiovascular disease, infectious disease, musculoskeletal disorders — the leading causes of morbidity and mortality in women — were dramatically underrepresented.

Women’s health, as reflected in its own journals, was still largely synonymous with reproductive health.

As the health policy scholar Carol Weisman documented, women’s health was historically “equated with reproductive functions,” and broader definitions only emerged in recent decades, driven largely by feminist critiques of medical institutions and advocacy that demanded a different frame.

PCOS inherited a way of thinking that was already decades old. And the institutions that should have updated it instead reinforced it.

Seen in that context, the history of PCOS begins to look less like an anomaly and more like a symptom.

The Framework Beneath the Name

The reproductive framework did not simply give PCOS a misleading name. It shaped every institution through which the condition was understood and managed.

Research funding flowed through reproductive channels. At the NIH, PCOS funding was channeled primarily through reproductive health programs — which meant that studies asked reproductive questions, produced reproductive findings, and trained subsequent researchers to ask reproductive questions again. The metabolic, cardiovascular, and psychological dimensions of the condition were not the focus of inquiry because they were not the focus of the funding.

Medical education reflected the same prioritization. PCOS was taught primarily as a condition relating to obstetrics and gynecology. It appeared in the section on menstrual irregularity. It was covered in the context of infertility management and ovulation induction. When I trained, insulin resistance was more a “footnote”. Cardiovascular risk was mentioned, if at all, in the same breath as other complications — not as a central feature requiring central attention.

Disease classification siloed PCOS into gynecology in ways that meant non-gynecological providers rarely considered it. A woman presenting to her PCP with fatigue, weight gain, and depression was unlikely to receive a PCOS workup. A woman presenting to a Cardiologist with metabolic risk factors was unlikely to be asked about her cycle history. The condition lived in the gynecologist’s office, and that is where it stayed.

Public understanding followed institutional understanding. Because the condition was framed as primarily reproductive, women with PCOS often did not know to connect their metabolic symptoms — their cravings, their weight gain, their insulin resistance — to the same underlying disorder. Many reported learning more from patient communities online than from their physicians. Many reported feeling confused about what their diagnosis actually meant for their long-term health.

The 2023 International Evidence-Based Guidelines for PCOS management represent a significant effort to correct this. They mandate assessment and management of reproductive, metabolic, cardiovascular, dermatologic, sleep, and psychological features — and they call explicitly for a lifelong health plan, not episodic gynecological care. That the guidelines felt necessary — that they had to say explicitly what had been omitted — is itself evidence of what the framework had cost.

The name did not create the framework. The framework created the name.

Medicine did not simply misunderstand a disease. It understood the disease through a particular way of seeing women.

And when institutions learn to see illness through a very particular (and very limited) lens, patients inevitably feel the consequences.

What Women Paid for That Framework

The costs of all of this is not theoretical.

Women with PCOS experience:

• Delayed diagnosis — on average, years between the onset of their symptoms and a formal diagnosis, during which time their metabolic risk accumulates without monitoring or intervention

• Confusion about their own condition — because the name points to ovaries, and many patients don’t understand why their energy, their weight, their mood, and their skin are all part of the same story

• Shame and self-blame — especially around weight, because insulin resistance is rarely explained, and weight gain is routinely attributed to poor habits rather than to the metabolic dysfunction actually driving it

• Dismissal — symptoms are frequently minimized, fragmented across specialties, or attributed to anxiety and stress

• Missed metabolic risk — the insulin resistance that sits at the center of the condition’s pathophysiology creates compounding cardiovascular and metabolic risk over time; when it goes unaddressed, so does that risk

• Fragmented care — a dermatologist for the skin, a psychiatrist for the mood, a gynecologist for the cycle, an primary care provider for the weight, none of them necessarily communicating, none of them necessarily connecting the dots

These are the predictable outcomes of a framework that located a metabolic disorder in the reproductive system—and kept it there.

The global survey conducted in advance of the renaming says a lot: Women with PCOS consistently reported that the name “polycystic ovary syndrome” was confusing, stigmatizing, and incomplete — and that it failed to capture what they were actually living with. They reported that it contributed to the dismissal they encountered in clinical encounters, and that it limited their ability to advocate for themselves because they didn’t have language that matched their experience.

Today, up to 70% of individuals affected by PCOS remain undiagnosed. A number like that does not reflects a rare or subtle condition—it reflects a framework failure.

Which is exactly why the debate over what to call this condition matters more than it might seem.

The Problem Was Never Just PCOS

The renaming of PCOS to PMOS is important because in medicine, what we call a disease often determine what we do about it. When the name of a condition changes — when “polycystic ovary syndrome” becomes “polyendocrine metabolic ovarian syndrome” — it changes what physicians look for, what researchers study, what patients understand about their own bodies, and how institutions allocate attention and resources.

A new name that encodes the metabolic and endocrine reality of this condition is a genuine corrective. It is not nothing. But it’s also not enough.

Not on its own.

Because the name was never the origin of the problem. It was a symptom of it.

The real problem is older and larger. It is the set of assumptions — embedded in research design, funding structures, medical education, clinical classification systems, and institutional practice — that equated women’s health with reproductive health. Medicine, research and public health still utilize the reproductive system as the organizing frame for understanding women’s bodies.

The PCOS story is, in this sense, a story about attention.

It’s about what medicine chooses to see when it looks at women. It’s about what biomedicine chooses to prioritize, to fund, to teach, and to name. It’s about a condition that is fundamentally metabolic was seen through a reproductive frame, and the women who lived with it absorbed the consequences of that seeing for decades.

Changing the name is the beginning of something — an institutional acknowledgment that the framing was wrong, that something important was missed, and that a correction is long overdue.

But what the correction requires is not just new nomenclature—It requires a broader reckoning with how medicine has historically reduced women’s bodies to their reproductive function, and a genuine commitment to what a more complete clinical attention would look like.

That means metabolic screening from the point of diagnosis. It means cardiovascular risk addressed throughout a woman’s life, and not only during her reproductive years. It means mental health integrated into the plan, not referred out as a separate problem. It means research that asks metabolic questions and funds metabolic answers. It means medical education that teaches the whole condition — not the part that sits most comfortably within an old framework that no longer holds.

The problem was never just PCOS.

The problem was a healthcare system that looked at women struggling with exhaustion, insulin resistance, depression, weight gain, and declining health — and kept asking:

“Are you ovulating?”

Thank you for Reading Health is Political

Dr. Brittani James is a Board-certified Family Medicine physician and co-founder of Twin Village Health, an Integrative medical practice in Chicago which provides physical and mental health care under one roof. She writes Health Is Political on the structural forces that shape who gets sick, who gets care, and who gets believed.

If this essay resonated with you, consider subscribing, sharing it with a friend, or joining the conversation in the comments

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How We Got Here

On May 19, 2026, a white Colorado Dermatologist named Dr. Travis Morrell filed a lawsuit in Manhattan federal court against Find A Black Doctor and its founder, Dr. Dina Strachan. Morrell was joined by Do No Harm — a conservative non-profit founded in 2022 with an explicit mission of opposing diversity, equity, and inclusion (DEI) initiatives in medicine.

The complaint argues that the directory's eligibility requirement — limiting listings to "Black physicians and dentists in active clinical practice" — violates federal civil rights law, specifically 42 U.S.C. § 1981, a provision derived from the Civil Rights Act of 1866 that prohibits racial discrimination in contracting.

Morrell says he applied to join in December 2025, never received a response, and that his application was "constructively rejected because he is white."

He is seeking compensatory and punitive damages, a permanent injunction against race-based listing requirements, and an order that his application to the Black physician directory be accepted.

Do No Harm's statement frames the directory as something that "indefensibly robs some physicians of valuable advertising exposure."

The lawsuit also takes direct aim at the concept of racial concordance — the evidence that patients may have better outcomes with physicians of the same race — calling it a "pernicious and debunked myth."

This is not the first time Do No Harm has pursued this strategy.

Earlier this year, the group reached a settlement with Penn Medicine (The University of Pennsylvania’s Health System) over a similar Black Doctors Directory, which was subsequently renamed and broadened in scope as a part of the resolution.

Find A Black Doctor was originally founded in 2005 and relaunched in 2019 by Dr. Strachan, a Harvard and Yale-trained Dermatologist, as a national resource for Black patients seeking culturally competent care. African Americans make up roughly 13% of the U.S. population but only 5% of practicing physicians.

The directory exists, in part, because that gap has consequences — and patients know it.

On its surface, the lawsuit appears to ask a coherent legal question: should any professional directory be allowed to restrict membership by race?

But that framing obscures a much more pressing question:

Why did patients feel the need for a directory like this in the first place?

The lawsuit focuses on the directory itself.

This essay focuses on why such a directory came into existence to begin with.

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What Black Patients Are Telling Us

The demand for Black physicians didn’t arise in a vacuum.

It emerged within a healthcare system where many Black patients describe a familiar pattern: feeling dismissed, stereotyped, unheard, or treated differently than the other patients because of their race.

Not every encounter is discriminatory. Not every physician is biased.

But when enough people report similar experiences across different cities, hospitals, clinics, and generations, the pattern itself deserves attention.

Most people assume physician choice is mostly about logistics —who takes my insurance? who is accepting new patients? who has an office close to home?

But in reality, patients often choose doctors for another reason.

In the case of Black patients, many are trying to maximize their chances of being heard.

That calculation becomes especially important when previous encounters have left them feeling misunderstood, judged, or unsafe.

The data reflects this. More than one in five U.S. adults report experiencing discrimination while receiving healthcare, with racial discrimination being the most commonly reported type. Among Black Americans specifically, over one-third report discrimination in clinical encounters.

In a study of more than 92,000 participants, nearly half of Black participants reported experiencing healthcare discrimination—compared to just over one-third of White participants.

But perhaps the most troubling finding of all is this:

22% of Black Americans report avoiding healthcare altogether because they anticipate discrimination.

As a physician, I find that number hard to ignore. After all—healthcare is one of the few institutions people are meant to turn to when they are scared, vulnerable, in pain, or facing the possibility that something is seriously wrong.

What does it mean that millions of Black Americans are so fearful of harm from our institution that they avoid it entirely?

The remarkable fact is not that some Black patients actively seek out Black physicians.

The remarkable fact is that enough Black patients have reported discrimination, dismissal, and unequal treatment to create demand for an entire physician directory.

Before asking whether a directory like this should exist, we should ask what conditions made it valuable.

Trust Is a Clinical Variable

Trust is not simply an emotional issue—it is one of the most consequential variables in healthcare.

I’ve spent enough years in medicine to see the healthcare system from multiple vantage points: as a patient, as a caregiver, as one of the 5% of practicing Black physicians, as someone involved in teaching medical students and residents and as someone in healthcare leadership responsible for healthcare operations and quality.

What became apparent from each of those different vantage points is that trust is not simply byproduct of good care—It is one of the essential conditions that makes good care possible.

A healthcare system can have the most advanced technology in the world, the newest medications, the most sophisticated diagnostic tools, and the most highly trained clinicians—None of that matters if patients do not feel safe enough to engage with it.

Trust influences whether someone seeks care when symptoms first appear or waits until a problem becomes more serious. It influences whether patients disclose sensitive information, whether they believe a diagnosis, whether they follow a treatment plan, and whether they return after a disappointing encounter.

Every clinician worth their salt understands this intuitively.

The patient who does not trust you tells a different story than the patient who does.

They hold things back for example. They delay. Sometimes, they disappear entirely. They seek second opinions.

And sometimes—they avoid the healthcare system altogether.

The consequences of distrust aren’t just interpersonal—They are clinical.

That is why the finding that nearly one-quarter of Black Americans have avoided healthcare because they anticipated discrimination is so important. It suggests that distrust is not a vague, peripheral phenomenon; but that it is quietly shaping whether people access the system at all.

Trust, then, is not merely a feeling.

In healthcare, trust functions as clinical infrastructure.

The Data Suggests Black Patients Are Not Imagining This

At this point, a skeptic might reasonably ask whether these concerns reflect perception or reality.

In other words, are Black patients actually being treated differently? Or are they simply interpreting ordinary frustrations with the healthcare system through the lens of race?

It’s an important question.

And fortunately, it’s one researchers have spent decades studying.

The evidence is remarkably consistent here. Here’s what we know:

1. Healthcare providers demonstrate measurable pro-White and anti-Black bias

A systematic review of 37 studies found that 31 demonstrated pro-White or anti-Black implicit bias among healthcare providers across multiple disciplines and training levels.

A separate review confirmed that most healthcare professionals show implicit bias at levels similar to the general population — and that this bias was significantly related to patient-provider interactions, treatment decisions, and health outcomes.

Perhaps most telling, every study that examined real-world clinical interactions found that providers with stronger implicit racial bias communicated less effectively with Black patients.

This is not a fringe finding—It is one of the most replicated findings in the health disparities literature.

2. Black patients' pain is systematically under-treated

For years, researchers have documented that Black patients are less likely to receive adequate pain treatment than White patients presenting with similar symptoms. This disparity has persisted despite decades of awareness and equity initiatives. The evidence is robust, and exists across multiple settings, study designs, and time periods.

For example, a large analysis of over 42 million pain-related emergency department visits found that White patients were 1.26 times more likely to receive an opioid prescription than Black patients — 40% versus 32% — even after adjusting for pain type, severity, insurance status, and geographic region. Black patients with long-bone fractures were 66% more likely to receive no painkiller at all despite similar expressed pain levels.

Perhaps most troubling: researchers found no meaningful change in the magnitude of these disparities over a 22-year period from 1999 to 2020. A follow-up meta-analysis reached the same conclusion — the gap has persisted despite a decade of policy changes and equity initiatives.

Part of this disparity appears to stem from persistent false beliefs about biological differences between Black and White people. A landmark study found that half of white medical students and residents endorsed false beliefs about biological differences between Black and White patients — including that Black patients have thicker skin or higher pain tolerance. Unsurprisingly, those who held these beliefs rated Black patients' pain as lower and made less accurate treatment recommendations.

These ideas are scientifically unfounded. Yet studies continue to find that they influence clinical judgment — and fit in seamlessly with a long history of racial pseudoscience that medicine has been slow to fully repudiate.

The result is a pattern of under-treatment that has been documented across emergency departments, surgical settings, and outpatient medicine.

3. Black patients receive fewer life-saving cardiac interventions

Black patients are less likely to be referred for cardiac catheterization, thrombolysis, implantable cardioverter-defibrillators, mechanical circulatory support, and heart transplantation—standard-of-care cardiac interventions that influence whether patients live or die.

In the studies, the referral gap is not explained by clinical presentation.

It IS explained by race.

When viewed collectively, these differences are difficult to dismiss as isolated incidents or individual misunderstandings.

They represent a pattern.

Perhaps nowhere is that pattern more visible than in maternal health.

4. Maternal mortality disparities persist across socioeconomic status

In the United States, Black women are three to four times more likely to die from pregnancy-related complications than White women, even when after adjusting for income and education levels.

Black infants are approximately twice as likely to die as White infants.

The usual explanations—education, income, personal responsibility, access to insurance—help explain some of the gap.

But they don’t explain all of it.

This is one of the most powerful examples in medicine of a disparity that defies the standard explanations. I will return to it.

The issue is no longer whether racial health disparities exist—Medical literature clearly says they do.

The question is why they persist. And to answer that, it helps to understand where they came from.

This Didn't Start Yesterday

One of the most common mistakes in conversations about race and healthcare is treating distrust as though it appeared out of nowhere—as though millions of Black Americans independently arrived at the same conclusion for no particular reason.

But distrust, like trust, is earned.

The false belief that Black patients experience less pain, for example, is not a modern misunderstanding.

It is one of the oldest ideas in American medicine.

In the 1840s, J. Marion Sims—often called the father of modern Gynecology—performed experimental surgeries on enslaved Black women without anesthesia, despite the availability of ether and his use of it on White patients. The justification rested in part on the widely held belief that Black people experienced pain differently than White people.

The details of the theory have changed over time.

The underlying logic has not.

For generations, medicine repeatedly transformed racial assumptions into scientific facts, then used those “facts” to justify unequal treatment.

Decades before Sims, Thomas Jefferson speculated that Black people had a “lack of lung capacity” compared to White people. Louisiana physician Samuel Cartwright later transformed that pseudoscientific speculation into medical doctrine, claiming that Black lungs were inherently “20% deficient” and that forced labor was a “physiological corrective”.

These claims were used to justify slavery.

But they did not remain confined to the era that produced them.

For generations, the assumption that Black lungs were inferior was quietly embedded into the medical software used to interpret breathing tests — meaning Black patients were routinely told their lung function was normal when it wasn’t, because the machine had been calibrated to expect less from them.

Perhaps the most consequential betrayal came later.

From 1932 to 1972, the U.S. Public Health Service deliberately withheld effective syphilis treatment from 399 Black men in Tuskegee, Alabama — never obtaining informed consent, actively deceiving participants into believing they were receiving care, and denying them treatment even after penicillin became the accepted standard of care.

The disclosure of Tuskegee in 1972 didn’t just damage trust — it killed people.

Researchers later estimated that the revelation was associated with a 1.5-year decrease in life expectancy for Black men at age 45, driven entirely by medical avoidance in the aftermath.

That is the measurable health cost of institutional betrayal.

Events like these matter because they show that Black patients' fears were sometimes justified. Many times over, the institution entrusted with protecting health had instead been a source of harm.

The uncomfortable reality is that medicine has often treated Black patients differently—not only in individual encounters, but through the design of institutions, research practices, and clinical tools themselves.

Nor is this purely historical.

A 2025 review identified dozens of risk calculators, medications, and laboratory tests that continue to incorporate race as a clinical variable.

The American Thoracic Society issued an official statement to clinicians that explains why race and ethnicity should no longer be considered factors in interpreting the results of spirometry—It came out in 2021. In it, they acknowledged that people of color may experience “delayed disease diagnoses or reduced access to therapies” under the existing race-based standard of care lung testing method.

The race-adjusted eGFR equation, which assigned higher kidney function to Black patients and could delay referral for transplantation, was not revised until 2021.

To medicine's credit, many of these practices are now being reexamined. Major medical organizations increasingly recognize race as a social category rather than a biological one and have begun removing race-based adjustments from clinical practice.

That is progress.

But it is recent progress, arrived at slowly, against resistance, after centuries of the opposite.

When Black patients approach the healthcare system with caution, they are not responding only to the encounter in front of them.

They are responding to a history that has repeatedly taught them that medicine does not always deserve the trust it asks for.

It's Not Just Poverty

One of the most common responses to racial health disparities is that—they are not really about race at all.

They are about poverty.

And to a significant extent, that argument is correct.

Socioeconomic factors matter enormously. Income, education, employment, housing, and insurance access explain a large share of health differences between Black and White Americans. One detailed analysis found that these factors account for roughly 80% of the Black-White life expectancy gap in men and 70% in women.

That is not a trivial finding.

If America eliminated poverty tomorrow, many racial disparities in health would likely shrink dramatically.

That reality matters. Too often, discussions about racial disparities become trapped in a false choice between racism and socioeconomic status, as though only one can be true.

In reality, they are deeply intertwined.

The problem though, is that socioeconomic explanations, while important, don’t fully explain what we observe.

Even after accounting for income, education, employment, and other socioeconomic factors, roughly 20–30% of the Black-White life expectancy gap remains unexplained.

If poverty were the entire explanation, there should be little disparity left after adjustment. Instead, significant differences persist.

One of the most striking findings in the literature is what researchers call “diminished returns.”

The idea is simple.

When White Americans gain additional education, income, or occupational status, they generally experience corresponding improvements in health.

Black Americans experience those improvements too—but often to a lesser degree.

In other words, equal socioeconomic gains do not always produce equal health gains.

Researchers have proposed several explanations.

• Higher-income Black Americans are often more likely to find themselves in predominantly White institutions where they encounter discrimination, social isolation, or the chronic stress of being viewed as an outsider.

• Residential segregation can persist even at higher income levels.

• Wealth gaps remain larger than income gaps.

• And experiences of discrimination do not disappear simply because someone has a graduate degree or a high-paying job.

The result is that two people may appear similar on paper—similar education, similar income, similar employment—and yet experience different health outcomes.

This is why, again, the maternal mortality data is so unsettling: Education does not erase the disparity. Income does not erase the disparity. Professional status does not erase the disparity.

The usual explanations account for part of the story.

But they don’t account for all of it.

And if 20–30% of the gap remains after the standard explanations have been exhausted, then we are left with a more uncomfortable possibility:

Something beyond socioeconomic status is contributing to the difference.

And one of the places we have to look is the healthcare system itself.

Why Some Patients Seek Black Physicians

This is the section that is most likely to be misunderstood, so I want to be precise:

Seeking a Black physician is not, for most patients, a rejection of White physicians—not really.

Much more than that, it is a search for trust, understanding, and shared experience. Black patients are often looking for a doctor who may require less explanation of certain things, who may be more alert to certain patterns, and with whom the work of establishing trust may begin from a different baseline.

The evidence supports this as a rational strategy.

What’s more, patients seek physicians who share aspects of their identity all the time.

Women seek female physicians for certain concerns. Members of religious communities seek physicians who understand their beliefs. Immigrants seek physicians who speak their language. Members of the military often seek clinicians who understand military culture. People living with disabilities frequently seek providers who understand disability not as an abstract concept, but as a lived reality.

Most people don’t find these choices surprising.

Most of us intuitively recognize that shared experience can sometimes make communication easier, trust quicker to establish, and misunderstandings less likely.

The same logic helps explain why some Black patients actively seek Black physicians.

It’s not because they want a segregated healthcare system. It’s because they believe a physician who shares certain lived experiences may be more likely to understand concerns that have historically been minimized, dismissed, or misunderstood.

In the end, trust matters deeply in medicine. And that trust is shaped by history, personal experience and whether patients believe they will be listened to, taken seriously, and treated fairly.

Medicine has systematically damaged the trust of Black patients and they are making rational decisions in response to that damage.

Any honest reading of the evidence has to reckon with that.

When Institutions Fail, People Build Workarounds

At this point, it becomes easier to understand what a directory like Find A Black Doctor actually is.

It is not a political statement…It’s a workaround.

After all, workarounds are predictably what happen when institutions stop meeting peoples needs reliably enough, for long enough.

Long COVID patients built their own research networks when the medical establishment was slow to take their symptoms seriously. Disability communities have long maintained informal guides to accessible and respectful care. Patient advocacy groups for rare diseases often know more about cutting-edge treatment options than the average specialist. Mutual aid networks fill gaps that social services leave open. Disease-specific support groups become repositories of practical knowledge that clinical settings don’t offer.

This is true far beyond healthcare as well.

When public transportation is unreliable, people organize carpools. When formal childcare is unavailable, families build informal caregiving networks. When government systems fail, communities often create parallel systems to fill the gap.

Find A Black Doctor belongs within this broader pattern. It is not an anomaly. It is an instance of a recognizable human behavior: making your own map when the one you were given doesn’t show you what you need.

Long before Find A Black Doctor existed, patients were already creating their own maps of the healthcare system. They asked friends who to see. They warned each other about clinicians who dismissed symptoms. They shared recommendations in churches, barber shops, beauty salons, community organizations, and family group chats. They traded names. They compared notes. They built informal networks of trust.

The internet simply made those networks easier to scale.

The lawsuit treats the directory as the problem.

But the directory did not create the demand…The demand came first.

The directory is simply one community’s attempt to solve a problem that many of its members felt was not being adequately addressed elsewhere.

In the end, all of that raises a deeper question:

If enough Black patients felt the need to create, use, and sustain a resource like Find A Black Doctor, what exactly are they telling us about the healthcare system they are navigating?

Because people rarely build alternative systems when the primary system is working well.

Workarounds are often diagnostic.

They reveal where institutions are failing.

And sometimes they reveal failures that institutions themselves are reluctant to acknowledge.

The Wrong Question

The public debate asks: is the directory discriminatory?

That is a legal question, and courts may eventually answer it.

But it is not the question that explains anything important about American healthcare.

The more important question is: why did enough patients feel they needed it?

Do No Harm has already demonstrated what winning looks like for them: a renamed directory, broadened to include doctors who are not Black, its original purpose diluted into something more palatable.

That outcome tells us exactly what this lawsuit is for. It is not about advertising exposure—not really. It is about making race-conscious tools legally untenable — one settlement, one injunction at a time — in a specific political moment that has made that strategy viable.

Until we are willing to confront why a Black physician directory exists in the first place — what experiences led to it’s creation, what evidence sustains it, what institutional failures feed it — we risk making the same mistake the lawsuit makes.

Mistaking the response for the problem.

Because if the demand for a Black physician directory is ultimately rooted in experiences of discrimination, dismissal, unequal treatment, and distrust, then eliminating the directory does not eliminate the underlying problem.

It simply removes one response to it.

Millions of people got sick, then got sicker — and then stopped getting better.

They returned to doctors with exhaustion so profound it resembled neurological disease, with cognitive dysfunction that erased words mid-sentence, with hearts that raced simply from standing up.

They came back with normal labs. With “unremarkable” imaging. With the implicit suggestion—sometimes spoken and sometimes not—that perhaps the problem was something other than biological.

This is where Long COVID’s story really begins. Not in virology, but in a waiting room — and in the specific kind of dismissal that often follows, when medicine encounters suffering it cannot yet explain.

Here is the uncomfortable truth Long COVID forced medicine to confront: modern healthcare is far less prepared for complex chronic illness than many people once believed.

Long COVID did not arrive as a single disease with a single organ target.

It arrived as a moving constellation of exhaustion, cognitive dysfunction, autonomic nervous system dysfunction (problems with the body’s automatic functions like heart rate, blood pressure, and breathing), breathlessness, pain, and relapse — often without definitive laboratory abnormalities to explain it.

And in doing so, it did not merely introduce a new medical challenge—It exposed the fragility of a system built around the assumption that legitimate disease will reliably produce visible evidence.

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The Illness Medicine Couldn’t Fully Explain

The numbers alone are staggering.

An estimated 10–20% of people infected with COVID-19 develop Long COVID, with cumulative global incidence approaching 400 million people. The global economic impact is estimated at roughly $1 trillion annually

These are not figures that describe a rare complication..

They describe a mass disabling event.

What made Long COVID so confusing — for both patients and doctors — was how many different ways it could affect the body. More than 200 symptoms have been reported, spanning virtually every organ system. Some of the most common include:

• extreme fatigue

• worsening symptoms after physical or mental activity (called post-exertional malaise)

• “brain fog,” including memory and concentration problems

• problems with the autonomic nervous system — the body’s automatic functions like heart rate and blood pressure — including conditions like Postural orthostatic tachycardia syndrome (POTS)

• shortness of breath

• anxiety, depression, and sleep problems

• chronic pain

For many people, these symptoms came and went unpredictably, making the illness difficult to diagnose and even harder to live with. In some Long COVID clinics, fatigue affected up to 89% of patients, with cognitive problems nearly as common.

And yet — despite how disabling the condition could be — doctors still do not have a definitive test for Long COVID. No validated biomarker exists. ‘‘

Standard bloodwork often appears normal. Imaging scans are frequently unremarkable. A condition that has affected tens of millions of people worldwide remains, in many ways, invisible to medicine’s usual tools for proving disease.

The problem was not simply that Long COVID was new. The deeper problem was what that invisibility revealed: Modern medicine has become extremely dependent on illnesses that can be measured, scanned, categorized, and objectively confirmed.

Long COVID did not simply introduce a new chronic illness.

It exposed the limits of a healthcare system built around the assumption that illnesses are only fully real once they become visible through testing.

And once that assumption began to fail, something unsettling became visible: many patients with Long COVID were encountering patterns of disbelief that chronically ill people had been describing for decades.

When Symptoms Outpace Tests

In modern medicine, illnesses become easier to legitimize when they can be visualized, quantified, or objectively measured. Long COVID frequently resisted all three.

Patients arrived at clinical appointments with devastating functional impairment — unable to work, unable to sustain basic daily activities, unable to recover from even modest exertion — and left with normal labs, unremarkable imaging, and an absence of clear answers.

The post-exertional malaise that defines so much of the Long COVID experience is particularly cruel in this regard: it is a symptom that worsens with the very testing and rehabilitation that standard medicine might otherwise prescribe.

Researchers have proposed many possible explanations for Long COVID:

• lingering viral particles in the body

• immune system dysfunction

• nervous system injury

• microclotting and blood vessel damage

• reactivation of viruses like Epstein-Barr

• chronic inflammation

But doctors and researchers still do not fully understand what is driving the illness.

Even now, many Long COVID treatments are backed by limited evidence.

That uncertainty created a dangerous shift in how patients were treated.

“We cannot yet explain this” quietly became “this may not be real.”

And when clear proof is absent, the burden often shifts from medicine’s limitations onto the patient’s credibility.

The problem was not simply a lack of answers.

It was that the absence of proof was often treated as evidence that the suffering itself might not be legitimate.

But for many people living with chronic invisible illness, this experience was not new.

Long COVID simply forced the broader public to finally see it.

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The Patients Who Already Knew

Long COVID did not create medicine’s discomfort with invisible illness. It exposed a preexisting pattern that millions of patients had been navigating for decades.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, dysautonomia, POTS — these conditions share remarkable clinical overlap with Long COVID, and they share something else too: a history of being dismissed, minimized, and inadequately researched.

For many patients with these conditions, the sudden visibility of Long COVID was bittersweet. Mainstream medicine was finally confronting the same problems they had been trying to describe for decades.

And researchers are increasingly finding biological overlap between these illnesses as well.

Studies show major similarities between Long COVID and ME/CFS in autonomic nervous system dysfunction, blood flow abnormalities, exercise intolerance, and nerve injury. Researchers increasingly suspect that these illnesses may share some of the same underlying biological mechanisms.

For many disabled and chronically ill patients, Long COVID did not reveal a new medical phenomenon.

It revealed how selectively medicine has historically recognized suffering.

The patients who had been told their exhaustion was anxiety, their exercise intolerance was deconditioning, or their cognitive problems were psychological were not imagining their symptoms.

Medicine simply did not yet have clear answers.

And in many cases, the healthcare system lacked the humility to admit that uncertainty openly.

Long COVID reinvigorated research into ME/CFS and POTS — conditions that had long been underfunded and underrecognized — not because the science was newly available, but because the political and social conditions finally demanded it.

What changed was not the existence of invisible illness.

What changed was the number of people experiencing it all at once.

Once millions of previously healthy people began experiencing chronic exhaustion, cognitive dysfunction, and functional instability simultaneously, the limitations of the healthcare system became far harder to dismiss.

The System Was Built for Acute Disease

Modern healthcare systems are extraordinary at many things.

They are optimized for acute stabilization, procedural intervention, and emergency response. They excel when a patient presents with a broken bone, a heart attack, a bacterial infection — conditions with clear biological signatures, established treatment pathways, and the expectation of resolution.

They work best when:

• a disease has a clear cause

• testing identifies the problem

• treatment follows a predictable path

• recovery is expected

Long COVID fit none of those patterns.

Almost immediately, it became clear the healthcare system was not built for this kind of illness.

Around the world, hospitals and clinics rapidly created new Long COVID programs in real time. Multidisciplinary teams brought together primary care doctors, neurologists, cardiologists, pulmonologists, rehabilitation specialists, psychiatrists, and physical therapists because no single specialty could fully manage the condition alone.

But access remained uneven and fragmented.

Many patients struggled to find knowledgeable clinicians. Others bounced between specialists without receiving coordinated care. In many places, especially lower-income countries, Long COVID care barely existed at all.

Even in wealthier healthcare systems, the burden was enormous.

Patients with Long COVID required far more medical visits, more follow-up care, and more long-term support than healthcare systems were designed to provide.

The system was not designed for that.

It was not designed for chronic ambiguity, multisystem illness, longitudinal complexity, or fluctuating disability. It was designed for throughput — for the patient who comes in, receives a diagnosis, receives a treatment, and gets better. Long COVID patients often did none of those things on schedule.

Long COVID confirmed a difficult reality: modern healthcare systems are optimized for diseases that can be rapidly diagnosed, categorized, and treated — not illnesses that require uncertainty tolerance, longitudinal care, and deep listening.

The crisis of Long COVID was not simply scientific.

It was structural.

But the consequences extended far beyond diagnostic uncertainty. Long COVID also destabilized assumptions about productivity, recovery, and the social meaning of illness itself.

A Mass Disabling Event

Modern societies quietly depend on certain assumptions about the body:

• that people will remain productive

• that illness will usually be temporary and

• that recovery is the normal outcome.

Long COVID disrupted all three at scale.

The economic consequences have been enormous. Millions of Americans are now living with Long COVID, and most of the financial burden comes not from hospitalizations, but from lost ability to work. In the United States alone 44–48 million Americans with Long COVID generate costs of $2–6.5 billion annually, with over 90% attributable to productivity losses. Globally, the cumulative economic impact approaches $1 trillion per year — roughly 1% of the global economy.

But statistics alone cannot fully capture the damage.

They do not capture:

• careers interrupted

• relationships strained

• parents unable to care for children

• healthcare workers forced to reduce hours

• people losing independence

• the social isolation of relapsing-remitting illness that cannot be predicted or planned around.

The healthcare workforce itself was not spared. Healthcare workers report higher rates of Long COVID than other occupational groups, and those affected experience significantly higher burnout, anxiety, and depression compared to colleagues who had COVID-19 without developing Long COVID. A longitudinal UK study found that most affected healthcare workers continued working in a reduced capacity — with reduced hours, different roles, or modified duties — and many reported feeling dismissed by their own physicians. (There is a particular cruelty in the clinician who cannot be believed by their colleagues.)

Long COVID forced millions of people into direct confrontation with a reality disabled communities had long understood: health is fragile, recovery is not always linear, and human worth cannot be reduced to consistent productivity.

Former US Surgeon General Jerome Adams put it bluntly this week:

“Long COVID’s disability & suffering will be the pandemic’s most devastating long-term global legacy. Neither GBD supporters nor critics anticipated its scale or included it in their policy calculus — and ‘let er rip’ strategies prioritizing widespread exposure clearly worsen the toll.”

It is a striking statement from the man who served as the nation’s top public health officer.

And the data now exist to back it up.

The numbers also expose something more uncomfortable than economic disruption: a systematic failure of research prioritization.

A 2026 study published in Communications Medicine found that Long COVID’s disability burden — measured in years lived with disability — rivals that of Alzheimer’s disease and asthma. And yet Long COVID received just 14% of its disability-commensurate NIH funding: $106 million annually against the $739.8 million its burden would warrant. The same study found that ME/CFS, the condition with the greatest clinical overlap with Long COVID, received less than 1% of its proportionate funding.

The pattern is not random.

Among conditions receiving the least funding relative to their disability burden, the majority are female-predominant. Conditions primarily affecting men receive a median of 5.2 times more NIH funding per year lived with disability than conditions primarily affecting women.

The suffering was real. The resources were not commensurate.

The relapsing-remitting nature of Long COVID was particularly destabilizing to productivity culture’s assumptions. This is not an illness that follows a clear trajectory toward either resolution or stable disability. It fluctuates.

Good days are followed by crashes. Exertion that seemed manageable one week can trigger weeks of worsening the next. This pattern is familiar to patients with ME/CFS and other complex chronic conditions — but it was unfamiliar, and profoundly disorienting, to millions of people who had never before encountered illness that did not eventually resolve.

In that sense, Long COVID did not merely challenge medicine. It challenged cultural assumptions about the body itself.

And perhaps that is why the condition became so destabilizing. Long COVID forced medicine into a level of uncertainty and ambiguity that modern healthcare culture often struggles to tolerate.

The Humility Crisis

Long COVID forced medicine to confront something it often struggles with: uncertainty.

Medicine does not like not knowing.

That discomfort is, in some ways, a feature rather than a bug — it drives inquiry, motivates research, pushes clinical thinking toward precision and accountability. But it also creates a pathological response to genuine uncertainty: when medicine cannot fully explain suffering, it sometimes begins to question the suffering itself—rather than the limits of knowledge.

Long COVID made this tendency impossible to ignore.

The same condition that prompted patient advocacy on social media before formal medical recognition —patients characterizing and naming their own illness because medicine had not yet done so — also prompted a paradigm shift in how guidelines are written.

A key multidisciplinary collaborative statement now explicitly states that treatment recommendations should be delivered with humility because there are many persistent unknowns, and emphasizes validating patients’ experiences — a phrase that would have seemed unnecessary to include in clinical guidelines a decade ago.

(That it must now be said is itself a measure of how far medicine had drifted from that basic commitment.)

There is also the NIH RECOVER Initiative which represents a landmark investment in post-infectious syndrome research.

But the gap between investment and burden remains striking. The Communications Medicine analysis found that disability burden explains just 6.5% of the variance in NIH funding levels across conditions — meaning that for most diseases, how sick people actually are has little bearing on how much research money flows toward understanding them.

Prior funding, not current suffering, is the most powerful predictor of future funding. For conditions like Long COVID and ME/CFS — newer, predominantly affecting women, and historically dismissed — this creates a compounding disadvantage that no single initiative can fully overcome.

New patient-reported outcome measures and research indices were developed that could have applications far beyond Long COVID itself. These are meaningful advances. They represent medicine’s capacity for self-correction when the evidence demands it.

But the deeper issue was never merely the absence of answers—Medicine will always encounter diseases it does not yet fully understand. It was how healthcare systems behave when answers do not yet exist — whether they default to patient disbelief, or whether they can hold uncertainty with intellectual honesty and ethical seriousness.

Long COVID did not simply expose gaps in scientific knowledge. It exposed the consequences of building healthcare systems that often mistake what cannot yet be measured for what is not real.

That is the reckoning Long COVID demands. Not merely better treatments, better biomarkers, or better clinical protocols — though all of those matter enormously to the millions still suffering.

The deeper demand is for aa healthcare system more capable of listening before certainty arrives.

A system willing to say:
“We do not fully understand this yet” without implying:

“Therefore it may not be real.”

Whether medicine is fully capable of making that shift remains an open question.

But Long COVID has made it impossible to pretend the question no longer matters.

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When Patients Stop Feeling Believed

Patients increasingly use the term “medical gaslighting” to describe an experience that has become disturbingly common in modern healthcare:

knowing something is wrong while being repeatedly told that nothing is.

The language is familiar to anyone who has been in that room—Your labs are normal. It’s probably stress. You might want to think about your weight. Have you considered that this could be anxiety?

The words are delivered with “clinical" neutrality” — sometimes even with warmth — and yet they land like a cement block to the soul. Often, the patient walks out of the encounter with their clinician with no clear diagnosis no plan, no guidance, and the creeping suspicion that the problem may not be in their body at all.

It may be in them.

This is why the phrase “medical gaslighting” resonates so widely. It names something that was previously unnameable — the experience of being disbelieved by a system you have been taught to trust. It captures not just frustration but a particular kind of psychological wound: the sense that your own perception of your body has been rendered unreliable by someone in a white coat.

But before going further, there’s something I want to be clear on:

Not every missed diagnosis is gaslighting.

Medicine is a genuinely uncertain science. Diagnostic errors are common, often unavoidable, and frequently made in good faith. I say that because I want to be clear that, in my view, the issue is not imperfection.

The issue is dismissal — the pattern of closing a clinical encounter without adequate evaluation of a patient’s genuine concern, often leaving them with shame and self-doubt rather than a plan of action. That distinction is critical.

This essay is about the latter.

And reducing medical gaslighting to individual communication failures misses something deeper and more unsettling: the extent to which modern healthcare systems themselves may be structurally producing these encounters.

Who Gets to Be Believed in Healthcare?

Medical gaslighting has been formally defined as “an act that invalidates a patient’s genuine clinical concern without proper medical evaluation, because of physician ignorance, implicit bias, or medical paternalism.” It sits within a broader category researchers call “dismissive medicine” — a pattern of mistreatment that includes symptom invalidation, blame, stigmatization, and the failure to listen in a meaningful way.

Underlying this phenomenon is the concept of epistemic injustice — the unfair dismissal of a person’s knowledge about their own experience. Philosophers use a more specific term: testimonial injustice, which occurs when a speaker is given less credibility than they deserve because of identity-based prejudice.

In clinical settings, this plays out when a patient’s account of their own body is treated as suspect — requiring external validation before it is taken seriously, while the same account from a different patient in a different body might not.

Sociological analysis has argued that medical gaslighting is not simply an interpersonal exchange but the result of deeply embedded and largely unchallenged ideologies underpinning healthcare — ideologies that include biomedical reductionism—the tendency to reduce illness to measurable biological abnormalities while overlooking emotional, social, environmental, and lived dimensions of health—paternalism, and structural inequities that disproportionately affect women, transgender, intersex, queer, and racialized individuals.

This framing matters because it reframes who is responsible.

It is not enough to say that some doctors are dismissive and others are not.

The more significant question is: what system conditions make dismissal the path of least resistance?

Medicine depends on patients reporting symptoms that can’t be directly observed. When the system systematically doubts certain patients, it undermines one of the foundations of clinical care itself.

The System Was Not Built for Complexity

Medical gaslighting persists because the healthcare system is organized in ways that make dismissal more likely.

This is not an accident.

It is a predictable outcome of a system designed around competing incentives — speed, productivity, measurability, and hierarchy — that are often fundamentally in tension with the recognition of complex suffering. There are several structural fault lines worth examining.

A. Assembly-Line Medicine

The modern clinical encounter has been engineered for efficiency. Physicians work under relentless productivity metrics, especially in corporate medicine. Physicians are reprimanded by administratrators for consistently taking more than 15 minutes with a patient. Slots are refilled the moment there is a cancellation, guaranteeing back-to-back visits and maximum revenue for the clinic administration.

The system itself is optimized for the common, the acute, and the clearly diagnosable.

Research has identified rushed visits, high patient turnover, and fragmented care environments as conditions that limit the ability to take thorough histories and build therapeutic relationships — contributing to premature diagnostic closure, the phenomenon by which a clinician settles on a diagnosis (or a dismissal) before adequate information has been gathered.

The patient with medically unexplained symptoms — whose illness requires time, ambiguity, and deep listening — does not fit this model. Their complexity becomes, in the logic of industrial medicine, a kind of inconvenience. A system designed for efficiency will often struggle with patients whose illnesses require time, ambiguity, and deep listening.

Therefore, our system struggles with complex and chronically ill patients.

When the appointment is over and nothing is “found,” the easiest exit is to suggest the problem is psychological, exaggerated, or not real.

That exit is structurally incentivized.

B. When Medicine Can’t Measure Suffering

Modern biomedicine privileges what it can measure. Lab values, imaging results, biopsies — these are the currencies of diagnostic legitimacy. When tests return normal, the system often treats this not as a gap in its own knowledge but as evidence against the patient’s account.

A systematic meta-synthesis of 151 qualitative studies representing over 11,000 individuals found that symptom invalidation in conditions with contested or poorly understood biomarkers leads to shame, suicidality, healthcare avoidance, and diagnostic delay. The conditions most affected — fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome, endometriosis, long COVID, Ehlers-Danlos syndrome, vulvovaginal disorders — share a common feature: they involve real, disabling suffering that does not always show up cleanly on a test.

The absence of definitive biomarkers is often treated not as a limitation of medical knowledge, but as a limitation of patient credibility. The patient is told, in effect, that because medicine cannot find the problem, the problem may not exist. This is a profound epistemic reversal — one that places the burden of proof on the person suffering rather than on the diagnostic tools being used.

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C. The Unequal Burden of Proof

The burden of proving one’s suffering is not distributed equally.

Healthcare professionals exhibit the same levels of implicit bias as the general population, and these biases influence diagnosis, treatment decisions, pain management, and communication patterns. Cognitive biases have been associated with 28% of diagnostic errors. The harms fall disproportionately along lines of race, gender, and other marginalized identities.

Stigmatizing language in medical records — words like “insists,” “claims,” “denies” — is more frequently found in the records of Black patients and women, conveying skepticism about credibility and perpetuating cycles of testimonial injustice. These racial and ethnic inequities are well-documented across obstetrics and gynecology and beyond.

Sociological analysis has identified transgender, intersex, queer, and racialized individuals as disproportionately affected by the ideologies that produce dismissive medicine. These patients are not merely more likely to encounter a bad clinician. They are more likely to find themselves seeking care in a system that was not built with their bodies, their histories, or their credibility in mind.

Bias is not incidental to the healthcare system—it is reproduced institutionally, through documentation, training, protocols, and the hierarchy of credibility that determines whose suffering actually matters.

D. Structural Barriers, Structural Harm

The problem does not end in the exam room. Residential segregation, socioeconomic disadvantage, language barriers, and inequitable distribution of healthcare resources create environments where diagnostic errors and dismissal are more likely — and where patients have fewer resources to seek second opinions or advocate for themselves.

Patients with limited English-language health literacy or disadvantaged socioeconomic position report unique contributing factors to diagnostic errors, including lack of qualified interpreters, inability to keep follow-up appointments, and inability to pay for care.

These are not personal failures, despite Industrial Medicine often naming them so. They are structural ones.

A systematic review of qualitative literature on diagnostic delay among underserved racial and ethnic patients confirms that dismissal and delayed diagnosis are socially patterned — clustering among patients who already bear the greatest burdens of illness and the least institutional power to demand better care.

This proves that diagnostic failure is not random—it is socially organized.

The Consequences of Not Being Believed

The consequences of medical gaslighting are not just emotional. They are measurable, serious, and in some cases, life-threatening.

In a recent JAMA Network Open study of patients with vulvovaginal disorders, 52.8% considered stopping care altogether because of gaslighting experiences. Those who saw more clinicians had higher distress levels and more frequent gaslighting encounters — a perverse dynamic in which persistence in seeking care is met with escalating invalidation.

Delays caused by dismissive behavior can lead to worsening morbidity, including delayed cardiac and cancer diagnoses. In conditions like endometriosis — with patients waiting an average of 4–11 years from symptom onset to diagnosis — the cost of not being believed is disease that is further progressed, increased surgical complexity and fertility lost while waiting for someone to take the suffering seriously.

Broader research on invalidation in healthcare documents the downstream effects systematically: shame, suicidality, healthcare avoidance, and diagnostic delay. Beyond being isolated outcomes, these form a consistent pattern in which disbelief of the patient becomes its own form of medical harm.

Patients don’t just leave these encounters feeling offended. Oftentimes, they leave feeling unsafe, hopeless, and increasingly unwilling to seek care at all.

Medical gaslighting is not a communication problem or an inefficiency of the system to be optimized away. It is a betrayal of the foundational contract between medicine and the people it exists to serve — and one that the profession has yet to fully reckon with.

Beyond Better Communication

There is a reflex in healthcare to address these problems with communication training. The go-to solve by administrators is to simply “teach clinicians to listen better”, and add a module or two on implicit bias to the med school or residency curriculum.

These efforts are not worthless; but they are insufficient.

That’s because the bigger problem is structural, not individual.

Studies show that individual bias training alone is insufficient without systemic change. You cannot communication-train your way out of structurally produced dismissal.

In other words, a clinician who genuinely wants to listen well but has seven minutes for an appointment and a productivity quota to meet is not going to solve medical gaslighting through better empathy. The conditions of the encounter make adequate listening nearly impossible.

What is required instead goes several layers deeper. Evidence-informed strategies include structural competency curricula — teaching clinicians to recognize the social and institutional forces that shape health and diagnosis — alongside the elimination of stigmatizing language in documentation, relationship-centered communication models, and policy modifications to address the organizational conditions that enable dismissive care.

Across obstetric and gynecologic care and other specialties, calls for diagnostic equity have become more urgent and specific: better representation in research, reform of documentation practices, longer and better-resourced appointments for complex patients, and accountability mechanisms for dismissive care.

More time, less stigmatizing documentation, believing patients as an institutional value, not a personal virtue and organizational reform are all interventions that the evidence points toward — but they require investment, will, and a willingness to acknowledge that the problem is built into the system’s architecture, not merely into its personnel.

What Patients Are Really Telling Us

The phrase “medical gaslighting” did not emerge from academic journals. Instead, it emerged from patients — from people trying to name something that had happened to them, that had no name, and that they had been made to feel was their own fault.

Its rapid spread across social media, patient communities, and chronic illness forums reflects something important. It speaks to a widening recognition that something is structurally wrong with how modern healthcare encounters suffering it cannot quickly categorize, measure, or cure.

When a term resonates with millions of people across different conditions, different countries, and different clinical contexts, it is worth asking: what are they collectively perceiving?

The answer, I believe, is this: a healthcare system organized around speed, biomedical reductionism, hierarchy, and inequity — a system that often lacks the time, the incentives, the training, and the moral purity required to recognize complex suffering.

Yes, clinicians themselves are often dismissive. That’s real. But dismissive, time-pressed clinicians are also, in a real sense, a symptom.

The growing use of the term “medical gaslighting” may ultimately reflect something larger than patient frustration. It may represent a widening public recognition that modern healthcare too often lacks the structural capacity to recognize suffering that is complex, chronic, poorly understood, or socially marginalized.

The question is no longer whether medical gaslighting exists. The more uncomfortable question is why so many patients experience it often enough to believe it is built into the system itself.

On May 4, 2026, HHS Secretary Robert F. Kennedy Jr. stood before the Make America Health Again (MAHA) Institute’s Mental Health and Overmedicalization Summit and announced what he described as “clear and decisive action” to confront America’s mental health crisis—by targeting the overuse of psychiatric medications.

“Today, we take clear and decisive action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications—especially among children,” Kennedy said.

“We will support patient autonomy, require informed consent and shared decision-making, and shift the standard of care toward prevention, transparency, and a more holistic approach to mental health.”

At first glance, this sounds reasonable—even overdue.

There are legitimate concerns about psychiatric polypharmacy, premature escalation, and poorly monitored long-term prescribing. I understand why this message resonates.

Americans sense—correctly—that something has gone very, very wrong with mental health care in this country.

And the data suggest they are right about that.

Rates of anxiety, depression, loneliness, overdose, burnout, suicide, and psychological distress continue to climb—even as psychiatric medication use has expanded dramatically over the last several decades.

To many, this looks like proof that psychiatric treatment itself has failed.

But what I have witnessed in clinical practice—and what the research more carefully shows—is that this is not simply a problem of “overprescribing.”

It is a far more uncomfortable reality.

What we are seeing is the slow collapse of a mental health care system that no longer creates the conditions necessary for careful diagnosis, thoughtful sequencing of treatment, longitudinal monitoring, or sustained therapeutic relationships between doctor and patient.

And if we accept the MAHA framing—and its deceptively simple solution of incentivizing clinicians to deprescribe—we risk doing three things at once:

• harming the patients who depend on these medications

• leaving the system that produced this problem completely intact

• and calling it reform

So before we act, we need to understand what is actually going wrong.

So let’s talk about it.

What the Evidence Actually Shows — and What It Doesn’t

Let’s start with the data itself, because it is worth taking seriously on its own terms.

In one widely cited study, researchers analyzed psychotropic prescribing patterns among 5.1 million recipients in a private insurance database and found that a substantial proportion of psychotropic prescriptions (medications that affect the mind, emotions, behavior, and mental activity) were given to patients without a formally documented psychiatric diagnosis associated with the visit.

Depending on the medication class:

• 42% of antidepressant visits

• 58% of stimulant visits

• 65% of anxiolytic and sedative visits

occurred without an associated psychiatric diagnosis.

Another analysis of the National Ambulatory Medical Care Survey found that roughly 60% of new psychotropic prescriptions were initiated without any documented psychiatric diagnosis.

A separate study examining outpatient anti-depressant prescribing trends from 1996 to 2007 found that the proportion of antidepressants prescribed without a documented psychiatric diagnosis increased from 59.5% to 72.7%.

And among patients with newly diagnosed depressive episodes, approximately 14% started an antipsychotic within one year. Of those prescribed antipsychotics for non-psychotic depression, 71% had not first received minimally adequate antidepressant treatment. This suggest pre-mature escalation to a drug class with substantial metabolic and neurologic risks.

If you stop reading there, “overprescribing” sounds like a reasonable conclusion.

But if you look more closely, a different picture emerges.

What these studies actually describe is not simply “too many medications.” They describe 1) medications prescribed without diagnostic clarity, 2) escalated without adequate follow-up, and 3) continued without meaningful reassessment.

That is a fundamentally different problem.

And it demands a fundamentally different solution than the one currently being offered by Secretary Kennedy. and the MAHA movement.

Importantly, none of this means psychiatric medications are inherently illegitimate or unnecessary. Severe depression, bipolar disorder, panic disorder, OCD, PTSD, schizophrenia, and other psychiatric illnesses can be profoundly disabling — and at times life-threatening. Psychiatric medications absolutely help many patients.

The problem is not that psychiatric medications exist.

The problem is that our system uses medications to compensate for inadequate visit length and the collapse of continuity, therapy and psychiatrist access, social support and long-term care.

If this were simply a problem of overuse, the solution would be straightforward: prescribe less.

But if medications are being used to compensate for gaps in care, then the question is no longer simply how much we prescribe—but how and why we prescribe at all.

When you look closely at the literature—and at the reality of clinical practice—a pattern begins to emerge. Not a single failure, but a system of failures.

They are distinct. They are interconnected. And together, they reveal the deeper architecture of what has gone wrong.

The 3 Failures Fueling the Prescription Crisis in Psychiatric Care

The literature, in my view, reveals three distinct but interconnected failures.

• Failure of indication

• Failure of sequencing

• Failure of monitoring

Each one matters separately.

And each one points toward a much deeper structural crisis inside American medicine.

Let’s dig into these.

Failure #1: Indication Failure

The reality is that a striking proportion of psychotropic prescriptions occur without clearly documented psychiatric diagnoses.

But that does not necessarily mean physicians are acting recklessly.

It often means clinicians are practicing inside systems that no longer create the conditions necessary for diagnostic clarity.

Let me explain.

Unlike diagnosing pneumonia, diabetes, or a fracture, psychiatric diagnosis rarely offers clean biological boundaries. Clinicians are often working with overlapping symptom clusters, incomplete histories, trauma narratives, sleep disruption, substance use, chronic stress, relational instability, and social suffering — all compressed into brief clinical encounters.

In practice, it means we’re often treating symptoms as they show up, rather than treating a clearly defined condition from the start. Or that we’re starting a medication, watching how the patient responds, and then tweaking things—rather than working from a fully defined diagnosis for the start.

Here’s an example.

Let’s take two common psychiatric diagnoses: major depressive disorder (MDD) and generalized anxiety disorder (GAD).

From both the patient’s and clinician’s perspective, these conditions share extensive symptom overlap:

• fatigue

• insomnia

• difficulty concentrating

• irritability

• psychomotor agitation

—all of these symptoms appear in both diagnostic frameworks.

To complicate matters further, they also co-occur (exist at the same time in one person) at extremely high rates. Roughly 60% of patients with generalized anxiety disorder also meet criteria for major depressive disorder.

In a busy primary care clinic, they are frequently difficult to disentangle.

In that setting, the diagnostic distinction may not be carefully made — or carefully documented — yet an SSRI is prescribed anyway because it is considered first-line treatment for both.

Clinicians, particularly in primary care, often respond with the only intervention that fits inside the time they are given.

In those situations, the antidepressant is more a “hypothesis” than a fully developed treatment plan.

Sometimes that hypothesis is correct.

Often, the patient doesn’t take the medicine long enough or stay connected to care long enough, to know.

Failure #2: Sequencing Failure

In medicine, sequence matters.

We are trained to move carefully through escalating levels of intervention:

1. Start with the safest and most evidence-based first-line treatment.

2. Give it adequate time.

3. Reassess the response.

4. Only then escalate treatment if necessary.

This approach exists for a reason.

Every escalation in treatment exposes patients to greater complexity, greater side effect burden, and greater risk.

But in the real world of American mental health care, this sequence often collapses.

The data increasingly suggests that clinicians escalate too quickly to higher-risk psychiatric interventions.

But what appears on the surface as poor prescribing behavior often reflects something deeper: compressed judgment.

Here is what sequencing failure looks like in practice:

A patient presents with depression. An antidepressant is started. But then…follow-up becomes inconsistent.

The patient misses appointments because of their work schedule, transportation barriers, childcare responsibilities, unstable housing, insurance problems, exhaustion, or simple emotional overwhelm.

Without consistent follow-up, the clinician loses the ability to:

• optimize the dose

• monitor side effects

• assess adherence

• evaluate therapeutic response

• or adequately explore the underlying contributors to the patient’s suffering

Let’s say a few months pass and the patient eventually return — and is still struggling.

At that moment, the clinician faces two paths:

1. Stay the course, optimize the first-line treatment, probe more deeply into trauma, sleep, substance use, relationships, and social stressors.

2. Add another medication.

In a healthcare system organized around continuity, time, and therapeutic support, we would more often choose the first.

In the healthcare system we actually have, we frequently choose the second.

Sequencing failure is not simply about poor judgment.

It is about “compressed” judgment.

This is because;

• there is not enough time to titrate carefully

• there is not enough patient access to ensure close follow-up

• there is not enough reimbursement for therapy and behavioral intervention

• there is not enough psychiatric consultation support

• and there is not enough infrastructure to address the nonpharmacologic drivers of suffering

After all, the fifteen-minute visit is the economic unit around which much of American outpatient medicine is organized.

Yet, mental health care requires history-taking, relational trust, nuance, observation, and longitudinal reassessment.

Our system simply does not make time for that kind of medicine. Especially in Primary Care, where most mental health care happens.

In the end, what looks like “too much medication” is ultimately the downstream consequence of too little time, too little continuity, and too little support to do treatment properly.

But there’s one more keyway our system fails.

Failure #3: Monitoring Failure

Psychiatric medications are not supposed to exist in clinical autopilot.

In theory, medications are started carefully, monitored closely, adjusted thoughtfully, and discontinued when risks outweigh benefits.

In reality, many medications are added and stay on to the point of permanence.

This happens for many reasons —Patients frequently move between clinicians and follow-up care fragments. And over time, the original rationale for treatment disappears from the chart.

What began as a temporary intervention slowly evolves into chronic medication burden without anyone deliberately deciding it should.

This is where psychiatric polypharmacy becomes especially concerning.

One longitudinal study found inpatient psychiatric polypharmacy averaging 4.5 medications per patient, with no efficacy advantage over monotherapy but two- to threefold higher rates of adverse drug reactions.

And yet in many settings, we still lack strong systems for:

• evaluating whether treatment is still helping

• de-prescribing when appropriate

• monitoring long-term side effects

In short, we are often far better at starting psychiatric medications than stopping them.

That is not just a “prescribing” problem — it is a problem relating to providing longitudinal care.

What Actually Drives These Failures

These failures do not emerge in isolation.

They are the predictable consequence of how American healthcare is currently organized. Factors include:

1. Psychiatry Access Collapse

Wait times for outpatient psychiatry routinely stretch for months as psychiatric workforce shortages are severe and worsening. Insurance coverage for mental health care remains deeply inadequate despite decades of parity legislation.

As a result, many of the patients most in need of specialized psychiatric evaluation are often the least able to obtain it.

2. Primary Care Has Become the Mental Health System

Primary care physicians increasingly manage depression, anxiety, insomnia, trauma-related symptoms, ADHD, substance use, behavioral crises, and severe psychosocial distress — often simultaneously.

I know this because I lived it for years.

The problem isn’t that primary care physicians treat mental illness —we can and we should.

And given the state of psychiatric access in America, we often must.

The problem is that we are managing conditions of escalating complexity without adequate infrastructure, specialist support, follow-up systems, or time.

It’s a recipe for failure.

3. American Culture and Pharmaceutical Expectations

Finally, there is also a broader cultural reality we rarely discuss honestly.

Americans increasingly expect rapid relief from suffering. And our healthcare system increasingly trains people to expect it.

Direct-to-consumer pharmaceutical advertising — legal in only the United States and New Zealand and banned everywhere else on the globe— reinforces the idea that emotional distress is primarily a problem to be rapidly corrected through consumption. Patients enter appointments already primed to believe medication is the obvious answer.

The slower work of therapy, behavior change, social repair, grief processing, trauma recovery, relational healing, or watchful waiting can feel intolerably insufficient by comparison. And clinicians, if nothing else, are trained to respond to suffering.

So we accommodate.

This is not because physicians “don’t care'“ or don’t consider the ethics of whether to prescribe or not. It’s because we are functioning inside a system built around rapid throughput, symptom reduction at any cost, and clinical interventions that can “scale”.

Medication scales.

Longitudinal healing often does not.

The Real Danger of the “Overprescribing” Narrative

This is why I worry about reducing this conversation to the language of “overprescribing.” Because it risks turning what is a structural crisis into an individual moral failure of doctors.

It allows policymakers to blame physicians while leaving untouched:

• our fragmented care systems

• therapy that is inaccessible

• the collapse of the psychiatric workforce

• economic precarity in the general population

• trauma exposure

• social isolation

• and reimbursement structures that reward speed over thoroughness

More importantly, it risks harming patients.

If the public conversation becomes simply “psychiatric medications are overused,” many patients who genuinely benefit from treatment will delay or avoid care altogether.

Yet, some patients absolutely need psychiatric medications. Some medications save lives.

The goal should not be indiscriminate reduction. The goal should be:

• better psychiatry.

• More careful diagnosis.

• Better care sequencing.

• better long-term monitoring.

• More therapy access.

• More time with your doctor

• More social work support

In other words: a healthcare system actually designed around healing rather than throughput.

The Wrong Question

Americans are correct to sense that something has gone deeply wrong in mental health care.

But the central question is not whether doctors prescribe too many psychiatric medications.

The real question is why psychiatric medications have become one of the only scalable responses to emotional suffering in modern American life.

That is a much more difficult question.

Answering it forces us to confront not only the failures of medicine, but the broader collapse of social, economic, relational, and therapeutic infrastructures that once helped human beings survive distress without medicalizing every dimension of it.

A healthcare system built around speed, fragmentation, and pharmaceutical throughput will continue producing the same outcomes even if prescribing rates fall.

And until we rebuild the conditions necessary for longitudinal human care, we will continue mistaking the symptoms of systemic collapse for the disease itself.

Share First, Do No Harm

There is a peculiar cruelty in how we speak of hunger in America.

We have constructed an elaborate mythology around poverty—one that insists that suffering must be deserved, that deprivation builds character, that those who accept help are somehow complicit in their own diminishment. Nowhere is this mythology more pernicious than in our national conversation about the Supplemental Nutrition Assistance Program, known as SNAP, or food stamps.

The rhetoric is familiar, almost ritualistic in its repetition: welfare queens gaming the system, able-bodied adults choosing dependency over work, taxpayer dollars funding irresponsibility. These narratives have a gravity to them, a weight that pulls our national discourse away from what SNAP actually is—a program that literally keeps people alive.

I want to tell you who really receives SNAP benefits, because the distance between perception and reality here is vast enough to swallow whole truths.

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Thirty-nine percent of SNAP recipients are children. Children. Not scheming adults manipulating a system, but young people whose primary transgression is being born into poverty. Another 10 percent are elderly Americans, people who spent decades contributing to a society that now requires them to prove their worthiness to eat. Roughly 20 percent of recipients are individuals with disabilities. The majority of working-age, non-disabled adult recipients are already employed—they work jobs that simply don’t pay enough to cover both rent and food, a choice no one should have to make in the wealthiest nation on earth.

These are not abstractions. Behind every percentage point is a grandmother rationing her medications to afford groceries, a child whose cognitive development suffers from chronic hunger, a parent working two jobs who still cannot fill the refrigerator.

The evidence of SNAP’s efficacy is not anecdotal or sentimental—it is measurable, reproducible, scientific. Dr. Seth Berkowitz and colleagues, writing in JAMA Internal Medicine, found that SNAP participation reduces healthcare expenditures among low-income adults, particularly those managing diabetes and cardiovascular disease.

Think about that for a moment: feeding people costs us less than treating the diseases that malnutrition causes. The math is almost insultingly simple, yet we resist it.

The research on children is even more stark. Studies published in the American Journal of Preventive Medicine and Pediatrics demonstrate that SNAP participation is associated with lower odds of poor health status, reduced developmental risk, and decreased emergency department utilization. Children with access to adequate nutrition are healthier, develop better, and require less acute medical intervention. This should not be surprising, and yet we treat it as though it were some radical proposition.

For older adults and racial minorities—populations that bear disproportionate burdens of diet-related disease—SNAP eligibility is associated with reduced prevalence of diabetes, hypertension, and stroke. When policymakers expanded SNAP benefits, researchers documented improvements in diabetes control and cholesterol.

Food, it turns out, is medicine.

Who knew?

There is something deeply American about our cognitive dissonance here. We claim to value self-sufficiency while structuring an economy that makes it impossible for millions to achieve. We say we care about children while debating whether they deserve to eat. We present ourselves as a Christian nation while requiring the poor to perform constant acts of justification for their hunger.

The mythology we’ve constructed about SNAP serves a purpose, though not a noble one. It allows us to avoid examining the systems that create poverty in the first place—the jobs that don’t pay living wages, the healthcare costs that bankrupt families, the housing markets that price out workers, the educational inequities that limit opportunity. If we can convince ourselves that poverty is a personal failing, we need not interrogate it as a policy choice.

But SNAP is not a handout or an act of charity. It is a recognition of a fundamental truth: that in a society as wealthy as ours, no one should go hungry. It is, quite literally, an investment in human survival and flourishing. Every dollar spent on SNAP generates economic activity. Every child fed is a child who can learn. Every elderly person who can afford groceries is someone who maintains dignity in their final years.

The medical literature I’ve cited here represents thousands of hours of research, millions of data points, peer review by experts across institutions. Research examining diet quality among food-insecure adults confirms that SNAP participation is associated with improved dietary quality and healthier weight status. Moreover, interventions combining financial incentives with nutrition education for SNAP beneficiaries demonstrate the strongest improvements in dietary intake, suggesting that thoughtful program enhancements could amplify these benefits.

It is as close to consensus as we get in social science: SNAP improves health outcomes. It reduces food insecurity. It lowers healthcare costs. It helps vulnerable populations survive and, occasionally, thrive.

Yet we continue to debate it as though these were open questions. We continue to means-test and stigmatize and create bureaucratic obstacles, as though the hungry must prove themselves worthy of eating. We continue to speak of program costs without acknowledging the human costs of going without.

I think often about what it means to live in a nation that has the resources to end hunger but lacks the will. About what it says about us that we can precisely calculate the benefits of feeding people—the reduced emergency room visits, the improved diabetes numbers, the better developmental outcomes—and still argue about whether it’s worth doing.

The architecture of SNAP is invisible to most Americans who don’t need it. They don’t see the difference between a child who eats breakfast and one who doesn’t, between an elderly person who can afford their medications and their meals and one who must choose, between a person with diabetes who can manage their disease through diet and one whose condition deteriorates into crisis.

But that invisibility does not make it less real. The lives saved are not less saved because they are not counted. The suffering prevented is not less prevented because it is not seen.

We have constructed elaborate justifications for letting people go hungry, narratives that comfort us in our indifference. But beneath all the rhetoric and mythology is a simple, stubborn fact: SNAP works. It saves lives.

And in a just society, that would be enough.

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It is midnight in America, and a woman is scrolling.

She is pregnant, restless, and her phone is the lantern she carries into the dark. A headline appears on her screen: “Tylenol in pregnancy may cause autism.” She does not know whether to keep scrolling or to stop. She does not know whether the white pill that has soothed her headaches for years now hides a darker price. She feels her belly, the possibility inside her, and wonders: whom should she trust?

This is the question of our time.

We live in a nation where trust in physicians and scientists has thinned to the point of translucence. Where once the white coat conferred an aura of certainty, now it is as much a target as a shield. Where science once occupied the pedestal of progress, it is now suspect—sometimes for good reason, often for dangerous ones.

And into this breach, in the vacuum left by eroded authority, step the performers of certainty: the populists, the strongmen, the influencers, the men who tell us that they alone can fix it.

The Fall of Deference

There was a time when doctors were not questioned. The physician’s word was near law, the scientist’s pronouncements carried the weight of scripture. To wear the white coat was to be robed in cultural armor, your authority second only to clergy or judge.

But the twentieth century delivered a series of betrayals. Tuskegee taught Black Americans that medical authority could cloak cruelty. Thalidomide scarred Europe with malformed births. Vioxx showed that profit could silence warning bells. The opioid epidemic proved that medicine could be bought, its authority wielded as weapon by corporations who understood how trust could be monetized.

Even where malice was absent, reversals eroded confidence. Eggs were dangerous, then they were healthful. Hormone replacement was salvation, then hazard. Fat was the enemy, then essential. Science is, by nature, a process of revision, but the public does not always hear it that way. To the average person, these reversals feel less like growth and more like betrayal.

Each stumble, each scandal, each pivot has chipped at the stone. Trust, once cathedral-like, now resembles ruins.

Into the Breach Walk the Populists

The vacuum did not remain unfilled. Demagogues and influencers rushed in, bearing the gift of certainty.

Donald Trump told us the experts were lying, that he alone saw the truth. Robert F. Kennedy Jr. assures audiences that vaccines are not salvation but conspiracy. TikTok health gurus promise quick answers, often dressed in the garb of science but divorced from its method.

Different tribes, same playbook: they speak in feeling, not data; in clarity, not complexity; in spectacle, not process. Their audiences are not students of science but congregants at a revival.

This is the populism of health. It thrives on a single gesture: the pointing finger. They lied to you. They don’t care about your children. They serve Big Pharma, not you. Against this, the populist casts himself as the lone truth-teller, the one unbought voice.

In this theater, ambiguity is weakness. Nuance is treason. Certainty is the ticket to virality.

Case Study: Tylenol and Pregnancy

Consider the recent controversy over Tylenol in pregnancy. A scientific announcement framed the drug as a possible risk factor for neurodevelopmental disorders. The media translated this into something more incendiary: an absolute that Tylenol in pregnancy causes autism. For a pregnant woman, such a headline is less “scientific nuance” and more thunderclap.

Enter Dr. Mike Varshavski, a physician and YouTube educator, who dissected the claim with sharp precision. He pointed out that the evidence was limited, the associations tenuous, the risk overstated. He worried aloud about what fear-mongering does to expectant mothers, how uncertainty inflated into alarm can cause more harm than the drug itself.

Here, in microcosm, we see the battle for health authority. The scientists announcing possible risk. The media amplifying it into spectacle. The physician pushing back with skepticism. And the public caught between.

What the public does not see is the painstaking work of science—the cautious parsing of data, the endless caveats. What they do see is the clash, the disagreement, the confusion. And in the absence of clarity, they turn to the figures who offer it most convincingly—regardless of whether it is true.

The Consequences of Spectacle

The cost of this dynamic is not theoretical. It is counted in lives.

Parents stall in paralysis, unsure whether to trust the doctor or the podcast host. Communities fracture along lines of belief rather than biology: one neighbor vaccinates, another refuses, both citing “science.” Public health becomes less about policy and more about persuasion in an attention economy where certainty is clickbait.

The deeper cost is to democracy itself. When health—the most intimate of concerns, the care of our bodies and children—becomes another battlefield for political spectacle, every citizen is conscripted. Every choice is politicized. Every life becomes collateral.

Toward a Different Covenant

The answer cannot be a return to blind faith. The myth of the infallible doctor, the unerring scientist, must die. What is needed is not deference but covenant: a new trust, grounded in transparency and humility.

This means scientists who tell us not just what they know but what they don’t. Physicians who admit limits rather than feign omniscience. Communicators who resist the urge to sensationalize uncertainty. Institutions that own their failures rather than bury them.

Trust can be rebuilt, but it must be rebuilt differently. Not as a fortress but as a bridge—held together by effort, repaired each time it cracks, sustained only if tended to over time.

Because between science and spectacle lies a fragile, necessary ground. A ground where complexity can coexist with clarity, where humility can coexist with authority, where truth is not decreed but shared.

The question is whether we will abandon that ground—or whether we will build again.

I was trained to believe in science the way others are trained to believe in God. The lab coat was my vestment, the peer-reviewed journal my scripture. For years I held fast to the creed that if one looked hard enough under a microscope, if one gathered enough data, the answers to human suffering would reveal themselves.

But science did not save me from disillusionment. Academic medicine promised truth and delivered profit. Corporate medicine promised efficiency and delivered dehumanization. I walked hospital corridors where patients became metrics, where colleagues bowed to billing codes rather than biology, and I wondered: is this all?

Then came George Floyd, his last breath pressed into the streets of Minneapolis, his death reverberating through Chicago, my city. At the same time, COVID tore through my community—through the lungs of the poor, the hearts of the elderly, the bodies of the Black and the brown. In those days I stepped outside the ivory tower and into the neighborhood clinics, into streets where loss was fresh and relentless. Chicago’s South Side, the land where the Panthers once organized, where Martin once marched, became my sanctuary.

It was there, amid grief and protest, that I began to unlearn the certainties I had carried. Faith had become science, and science had soured. I needed something higher.

Out of that rupture, I did something strange: I turned to the voices I had long been taught to despise. I began to listen to conservative influencers, Charlie Kirk among them. At first, it felt like trespassing on enemy ground. Their words were sharp, their critiques of people like me unrelenting. To listen was to risk being cut.

But I kept listening. And slowly I realized the terrain was not as foreign as I had once believed. Beneath the rhetoric I heard something familiar: the sense of betrayal, the rawness of anger, the fear of being unseen. I did not swallow their conclusions whole, but I learned to respect their search.

What became clear is this: belief is fragile. It bends with evidence, it shifts with time, it is molded by tribe. But Truth is higher than belief. Belief can change; Truth cannot.

And Love is the Truth.

This is the lesson medicine could not teach me, but humanity did: that there exists a middle way. Not the lukewarm compromise of “both sides,” but a way that begins deeper—at the soil of shared humanity. It is the recognition that before we are liberal or conservative, before we are believers in science or disciples of faith, we are bodies that bleed, lungs that ache, spirits that crave belonging.

As a physician, I know the body tells the truth more honestly than we do. Stress drives cortisol wild. Oppression raises blood pressure. Loneliness weakens immunity. These things do not care for your politics. Biology reminds us what belief obscures: we are bound together.

Charlie Kirk did not convert me. He did not make me abandon the convictions I hold as a Black physician in a wounded city. But his presence in my journey reminded me that conviction is not the same as Truth. That beyond the arguments and algorithms, beyond the fury of our factions, there is something that does not bend.

Love.

Love is not a cure-all, not a slogan, not an escape. Love is the hard work of seeing one another clearly, even when it hurts. For all of our differences of opinions, Charlie represents that work for me—the work of listening where we would rather turn away, of finding a face where we expect only an enemy.

And in that work lies the only chance we have—that from the ruins of our distrust, something whole might still be built.