Why does the setting matter so much?

The researchers offer a structural explanation. In primary care, women often arrive with complex, unclear symptoms before any diagnosis exists. A GP must distinguish thyroid problems from menopause, anxiety, depression and several other conditions, often under tight time constraints. That interpretive burden, not any failure of empathy, can leave patients feeling their experiences are not being recognized.

"It suggests that the challenges women face in primary care may be driven largely by the clinical setting itself," Zangelidis said. "Improving patient voice requires us to think about the knowledge, time and referral pathways available to support these consultations."

Specialists, by contrast, work with condition-specific knowledge and see patients whose symptoms are harder to misread. In that setting, the interpretation problem shrinks — and, interestingly, doctor gender reappears as a factor.

Among specialists, female specialists were associated with higher levels of patient voice than male specialists. The study authors suggest that once the structural difficulty of interpreting symptoms is reduced, the gender of the clinician may matter more.

Is this about deliberate dismissal?

The researchers are careful to push back on that framing. "There is an important distinction between saying that women are not being listened to and saying that doctors are deliberately ignoring them," said Catia Montagna, a professor at the University of Aberdeen. "Our research points toward a much more complex problem."

"When symptoms overlap between conditions, patients can struggle to have their experiences recognized," Montagna said. "Improving women's health care requires us to think about medical knowledge and communication, as well as the structures in which care is delivered."

Co-author Dr. Tapio Räsänen of Kela put it in systemic terms: "The important message is that patient voice is shaped by the clinical environment as well as by the individual interaction between doctor and patient. Understanding these structural factors can help improve women's experiences of health care."

What would improve things?

The study team argues that asking individual doctors to communicate better is not enough. Their proposed measures include:

• Better training on thyroid disease for clinicians
• Clearer referral pathways for patients with persistent or complex symptoms
• Sufficient consultation time for complicated, symptom-heavy cases

The findings arrive amid growing public concern about women's health, diagnostic delays and experiences patients describe as "medical gaslighting." Rather than confirming that health care professionals deliberately dismiss women, the study offers a systemic account: the way care is organized — who diagnoses whom, with what knowledge and how much time — can determine whether a patient's account of her own body is heard and understood.

The study has limitations worth keeping in mind. It focuses on one condition, thyroid disease, in one country, the U.K., and its measure of "patient voice" reflects patients' perceptions of their care rather than clinical outcomes. Whether the same pattern holds for other conditions, or in other health systems such as Finland's, remains to be tested.

The paper, "Epistemic injustice in healthcare: How doctor gender and speciality shape patient voice in women's thyroid care," appears in Social Science & Medicine (2026), DOI: 10.1016/j.socscimed.2026.119743.