On today’s post, Mara Floris explores the role of existing medical evidence in identifying instances of epistemic injustice. Mara is a philosophy of science researcher at Università Vita-Salute San Raffaele in Milan, working on epistemic injustice, healthcare communication, and gender-fair language.
Recent debates on epistemic injustice in healthcare have raised an important methodological question: how can we establish that epistemic injustice is occurring? Nielsen et al. (2025) argue that the field needs clearer conceptual criteria and stronger empirical evidence, particularly for claims about testimonial injustice. A response by members of the EPIC project develops this discussion, arguing for an empirically informed but methodologically pluralistic approach (Byrne et al., 2026). Færge et al (2026) similarly emphasise methodological pluralism. My recent paper takes this discussion in another direction: we need better ways of identifying epistemic injustice, but should also ask what existing medical evidence can tell us.
I focus on women's diagnostic experiences because they provide a well documented case. Across medical conditions, women experience longer diagnostic delays, repeated misattribution of symptoms, and differences in how their reports are treated in clinical encounters. These patterns are visible in patients' accounts and medical records.
Pain provides a useful example. Research has found differences in how women's and men's pain is interpreted and treated. Experimental studies can hold clinical information constant while varying only the patient's gender. This suggests that clinical management cannot always be explained by symptoms or disease. Endometriosis provides another example. Diagnosis can take many years. Biomedical complexity plays a role: symptoms vary and can be difficult to detect through imaging. Yet clinical guidelines recognise that diagnosis should integrate symptoms, clinical history, examination, and imaging, and that negative imaging does not exclude the disease. This raises questions about the weight given to patients' accounts.
Sometimes clinicians lack relevant knowledge. Medical research has historically treated the male body as a default, leaving gaps in knowledge about women's symptoms and diseases. Nancy Tuana describes this as epistemic ignorance. In other cases, relevant knowledge exists but is not appropriately incorporated into clinical reasoning. The problem is therefore which sources of evidence are treated as credible.
The same issue arises when patients develop their own diagnostic hypotheses. After unsuccessful consultations, patients may turn to patient communities or scientific literature. A patient's self diagnosis should not automatically be accepted as correct. But neither should it be dismissed simply because it comes from a non-expert. Their hypothesis can be treated as evidence and evaluated alongside other information.
A less visible form concerns patients' interpretive resources. If severe menstrual pain is repeatedly presented as normal, or if typical symptoms are represented primarily through male cases, people may lack resources to recognise that something is wrong. This connects pre-consultation delay with Miranda Fricker's concept of hermeneutical injustice.
Diagnostic delay is not, by itself, evidence of epistemic injustice. Delays can have many causes, including biomedical uncertainty, organisational problems, and limitations in diagnostic technologies. However, when different sources of evidence converge, and similar patterns recur across conditions and populations, they can provide grounds for an epistemic interpretation. We need clearer criteria and better empirical measures, but existing evidence remains relevant. In many cases, epistemic injustice is already visible in the medical record.
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| Mara Floris |
Recent debates on epistemic injustice in healthcare have raised an important methodological question: how can we establish that epistemic injustice is occurring? Nielsen et al. (2025) argue that the field needs clearer conceptual criteria and stronger empirical evidence, particularly for claims about testimonial injustice. A response by members of the EPIC project develops this discussion, arguing for an empirically informed but methodologically pluralistic approach (Byrne et al., 2026). Færge et al (2026) similarly emphasise methodological pluralism. My recent paper takes this discussion in another direction: we need better ways of identifying epistemic injustice, but should also ask what existing medical evidence can tell us.
I focus on women's diagnostic experiences because they provide a well documented case. Across medical conditions, women experience longer diagnostic delays, repeated misattribution of symptoms, and differences in how their reports are treated in clinical encounters. These patterns are visible in patients' accounts and medical records.
Pain provides a useful example. Research has found differences in how women's and men's pain is interpreted and treated. Experimental studies can hold clinical information constant while varying only the patient's gender. This suggests that clinical management cannot always be explained by symptoms or disease. Endometriosis provides another example. Diagnosis can take many years. Biomedical complexity plays a role: symptoms vary and can be difficult to detect through imaging. Yet clinical guidelines recognise that diagnosis should integrate symptoms, clinical history, examination, and imaging, and that negative imaging does not exclude the disease. This raises questions about the weight given to patients' accounts.
Sometimes clinicians lack relevant knowledge. Medical research has historically treated the male body as a default, leaving gaps in knowledge about women's symptoms and diseases. Nancy Tuana describes this as epistemic ignorance. In other cases, relevant knowledge exists but is not appropriately incorporated into clinical reasoning. The problem is therefore which sources of evidence are treated as credible.
The same issue arises when patients develop their own diagnostic hypotheses. After unsuccessful consultations, patients may turn to patient communities or scientific literature. A patient's self diagnosis should not automatically be accepted as correct. But neither should it be dismissed simply because it comes from a non-expert. Their hypothesis can be treated as evidence and evaluated alongside other information.
A less visible form concerns patients' interpretive resources. If severe menstrual pain is repeatedly presented as normal, or if typical symptoms are represented primarily through male cases, people may lack resources to recognise that something is wrong. This connects pre-consultation delay with Miranda Fricker's concept of hermeneutical injustice.
Diagnostic delay is not, by itself, evidence of epistemic injustice. Delays can have many causes, including biomedical uncertainty, organisational problems, and limitations in diagnostic technologies. However, when different sources of evidence converge, and similar patterns recur across conditions and populations, they can provide grounds for an epistemic interpretation. We need clearer criteria and better empirical measures, but existing evidence remains relevant. In many cases, epistemic injustice is already visible in the medical record.