This was an incredibly insightful read that changed the way that I view the healthcare industry (in the US). It tackles the issues of medical bias and patient dismissal in great detail with relevant anecdotes sprinkled throughout.

Honestly, I kept putting this one off because I was afraid that Marshall and Palokoff would leave me feeling gutted and forlorn- but they left me feeling more knowledgeable and empowered to take my healthcare into my own hands. (When dealing with professionals, of course. I don't intend to start self-diagnosing and treating.)

The thing that often gets overlooked when discussing the current medical climate is the empathy to view things from a Doctor's lens. I love the well-rounded approach that this book takes without casting unwarranted blame or prejudice. It simply presents trends as they are and helps us as patients to navigate the increasingly complex world of general medicine.

While I would like to re-read and highlight passages for reflection, I will need a break before returning to such an emotional subject.
A must-read for anyone who has felt unheard in the DR's office.

[Thank you to NetGalley and Kensington Books for a free copy of this book in exchange for an honest review.]

Dismissed had the potential to be a hard hitting book. Its author, Angela Marshall, a family doctor who has seen north of 50,000 patients, is hyper sensitive to people being dismissed by “professionals”, such as doctors, as they are, continually. Sadly, the dismissal parts of the book are far outweighed by the rambling justifications of and apologies for the medical fraternity and the standard wishlist for the entire healthcare complex of the USA.

The ways that doctors dismiss their patients is far broader and sometimes more shocking than expected. The stories Marshall has collected of patients “being fired” by their doctors, for say, not implementing the recommended regimen, or of patients firing their doctors for treating them like half-witted morons, are very moving. They occur in several places in the book, a relief from Marshall’s descriptions and (too well known) statistics of the healthcare-industrial complex, all off-topic and of no interest here.

Marshall says she doesn’t think there are more than the average percentages of ignorant, insensitive, biased and bigoted doctors; it just appears that way. Yet she says that a search of Google Scholar brings up millions of hits for “bias in healthcare.” So who is she kidding? Doctors are unfortunately in the god business; they hold the power of life and death. She admits doctors don’t like it when patients come in with their own diagnoses from “Dr. Google”, or if they don’t come in at all so the doctor can’t bill for it. The complaints in defense of doctors pretty much nullifies the dismissals of the title.

Dismissal falls upon a cascading list of minorities. It happens most to Blacks, to women, to other-gendered, the handicapped, the aged, and especially to the poor. It is no secret that the better your insurance and the more money you have, the better doctors will handle your case. As a poor Black woman (0-3), Marshall lost a baby son to an arrogant doctor who refused to be rushed in saving him, despite her reasoning and pleading. Doesn’t get much worse than that.

And bias goes deeper than that; it is ingrained. She cites the fact that 70% of those suffering chronic pain are women, but 80% of pain studies are carried out on men or male mice. Again, not news, but a fine example of dismissing the concerns of women in general.

Another example is native Americans. She cites the fact that the US spends less than half on the healthcare for them than it does for federal prisoners. Figures for Medicaid show American Indians even farther behind the poor. Interesting, but this is not an example of dismissal.

So it’s nothing new and the book keeps veering off course like this. Worse, it gets preachy. At one point, she falls into a trap of her own making, over race. She says that Asian Americans suffer from “all Asians look alike” assumptions, which, she says, “ignores Asian subgroups such as Chinese, Japanese or Korean, important differences that should be understood by health-care providers.” This is so abysmally insensitive as to cast doubt on the whole book. Body shapes, facial features and personality are in no way similar, fewer or restricted in Asians than in whites. Or Blacks. To think of it in terms of nationalities is massively insulting. Very disappointing to read that multiple national origins are the basis for Asians supposedly all looking alike. They don’t. At all.

Nor is it going to get better. Forty percent of first and second year medical students agree that “Black people’s skin is thicker than White people’s,” for example. And this is the next generation of doctors. So it would appear that no one is making headway in raising American children to treat all equally.

Rather than dive deeper into dismissals with perhaps interviews of experts, Marshall flies off on a topline apology for her profession. She says it is a misconception that doctors like to prescribe drugs and that they get paid for doing it. It is just too easy to defeat this argument. She makes several such naïve arguments, where any knowledge of the subject at all could negate her premise. She’s surprisingly superficial. There are endless and repetitive pages on how hard-pressed family doctors are, how they don’t make enough money, see too many patients, are pressured by the healthcare system the same way their patients are, are swamped with paperwork, and on and on. Pity the poor doctors is a large chunk of this book. Larger than the dismissed part.

The enormously disappointing conclusions are just a very long and standard wishlist for change in the American healthcare complex, separated into various constituencies such a patients, doctors, hospitals, insurers, and government. It contain the usual platitudes like “Root out anti-science bias.” Patients need to treat doctors better. Doctors need to treat patients better. Patients need to see a family doctor before going to a specialist. Same for going to the Emergency Dept. More money needs to be spent to fix the system. Got it.

At least, at the very end, she circles back to dismissing: “Dismissal leads to death. I don’t just mean literal loss of life, but also the death of the spirit, the death of dreams, the death of potential. Dismissal damages so many lives: a child with disabilities bullied at school, a worker excluded from a job because of race or gender, a beautiful body hidden in shame after disrespect in social media, a senior whose brilliant ideas are ignored because their hair is white. Each of these dismissals damages a human life. Sometimes that human manages to weld that damage into strength, but at other times we witness the destruction of a person and their potential.” If only she had stuck to this for the other 200 pages, it would have been a challenging and valuable read.

David Wineberg

Dismissed is an observational and anecdotal text about medical biases with concrete “prescriptions” for ways that our current health system can be changed to mitigate the issues caused by these inherent biases. It is rife with testimony from doctors and patients illustrating these biases, and it is written in a very clear, conversational style. I enjoyed the read! I think this read would be a great introduction to anyone unfamiliar with bias in medicine, but the action items and words for healthcare practitioners make it so any reader can get something out of it. I will say that I would like these action items to be detailed more thoroughly, perhaps in another supplemental text, or in sources and research clearly cited. For example, when the author talks about changing incentives for doctors to be outcome-based, what research does that rely on? What potential pitfalls does that have, and how can one account for the possibility of doctors underreporting remission or recurrence? What data are we consulting to supplement the authors’ own self-reporting survey collection? These are a few of the thoughts I had reading this book. I think this book will find a great audience in people on the patient side of the equation who are reluctant to combat biases, as well as anyone trying to understand why any racial or gender minority, disabled person, fat person, person experiencing poverty, woman, or any marginalized group may have a very different experience with the medical system than they will ever consider.

Dismissed; Tackling the Biases That Undermine our Health Care by Angela Marshall; Kathy Palokoff is a TIMELY book that should be read by everyone. The US has been in a health crisis since the beginning and we need to wake up and vote for change. An important book that belongs on every library shelf! I felt so lucky to get a copy for myself! I have shared on my goodreads, bookstagram, and booktok!

5 stars
Dismissed
Angela Marshall and Kathy Palokoff

Dismissed is an absolute must-read book for all doctors and patients, as both groups will learn a tremendous amount regarding medical bias and being dismissed. Authors Angela Marshall and Kathy Palokoff explain medical bias in a very alarming yet concise way that should frighten everyone. Because at some point, every single one of us will all be dismissed/ignored as a patient with the potential of real harm occurring due to either intentional or unintentional bias. The stories and statistics detailed within these pages are maddening and unfortunately all too relatable.
This book should be required reading for anyone going into the medical field.
I received a complimentary copy of this book from the publisher and Netgalley.