Disclaimer: This post is for informational and educational purposes only and reflects personal perspectives and cited research. It does not constitute professional medical advice, diagnosis, or treatment, and should not replace consultation with a qualified healthcare provider.See all disclaimers.
Note: This post expands on my recent ED experience which I described on social media. (You can also find it on Instagram, FaceBook, and TikTok.)
“Kindness always works.” “Just be polite.”
How many of us living with complex conditions have heard these platitudes when expressing frustration with medical providers? And how does hearing that actually make you feel when you are in acute distress?
To me, assertive self-advocacy and strategic navigation often go head-to-head with superficial ideas of “politeness.” Constantly being told to “be kind” conditions many of us—especially women—to freeze or fawn the moment an authority figure responds with skepticism. We sit on exam tables in severe pain, agonizing over whether speaking up will make us seem “difficult,” “demanding,” “rude,” or even just an “inconvenience”.
We have to unlearn that guilt. Directness is not rudeness. Stating clear facts, asking for a supervisor, or correcting a medical record is not being unkind—it is basic self-preservation. If a provider interprets calm, unwavering boundaries as “rude,” that is a reflection of their discomfort with being challenged, not a reflection of your character.
Caveat to “being respectful”
There is also a critical caveat to “being respectful”: providers must recognize that a patient who is visibly upset, tearful, angry, or exhausted is often reacting to fear, acute pain, or physical distress—not disrespecting the staff or the hospital. Take a beat, understand the overwhelming human factors at play, and see the bigger picture rather than tone-policing someone in crisis. Respect is a two-way street, but managing a provider’s comfort should never come at the expense of your life.
Strategic Navigation
When your respectful and polite attempts to communicate your needs hit a wall with a provider, strategic navigation must take over. Some examples include:
Targeted Escalation: Recognizing when a front-line provider (e.g., the Emergency Department PA/NP/Resident) is out of their depth and knowing how to request the attending physician or an on-call specialist without backing down.
Real-Time Fact Correction: Intervening when your medical history is misquoted, misunderstood, or reframed. Doing so isn’t being “difficult”, it is about your safety as a patient and can prevent misdiagnoses from following you through the system.
Breaking the “Curtain Illusion”: Calmly telling a provider you can hear them discussing your case outside the curtain, can reset the room. It transforms a dismissive sidebar into a standard of professional accountability. This becomes more important when you realize the provider is misinterpreting the concern. (e.g., “I heard you discussing my history, and I need to clarify that narrative before we move forward”.)
Provider deflection in an ER
Recognize provider deflection for what it is. When a provider says “we can’t help you here” or “call your outpatient doctor” for an emergency situation, that is rarely a reasoned medical judgment. It may be an attempt to dodge a case that they don’t understand or to clear their patient list before clocking out.
Some responses you can use in an ER when a provider says the phrases above or seems to downplay your situation, you can always say:
“I don’t feel safe leaving with [X, Y, Z]”.
“If you cannot help, then who is the on-call specialist who can”?
“If this hospital does not have [X specialist] or the tools, then I need you to arrange a formal, safe transfer to a hospital that does”.
“I understand this might be outside your comfort zone, but I need to speak with the attending ER physician or the charge nurse before any discharge paperwork is signed”.
Weaponization of passive compliance
Telling patients to simply “be kind” flattens the complex, well-documented realities of medical gaslighting—realities that disproportionately harm women, People of Color, and individuals living with complex multi-system illness. For marginalized and chronically ill patients, passive compliance is too often weaponized against them. Peer-reviewed research and major national consensus reports consistently demonstrate that:
Sex and gender bias in acute care is measurable and widespread: A 2024 analysis (Guzikevits et al, 2024) of over 21,000 emergency department visits published in PNAS found that female patients are significantly less likely to receive pain medication—both opioids and non-opioids—than male patients with identical pain scores, wait an average of 30 minutes longer for care, and are 10% less likely to even have their pain scores recorded by triage nurses. Controlled experiments confirmed that healthcare providers systematically judge female patients’ pain as less intense due to a “gender-pain exaggeration bias” that views women as overly emotional. This builds on decades of evidence showing women’s physical symptoms are routinely psychologized as emotional distress or anxiety rather than organic illness (Hoffman & Tarzian, 2001).
Acute care settings harbor documented racial disparities: In acute emergency departments, Black and minoritized patients face significantly longer wait times, lower assigned triage acuity, lower likelihood of hospital admission, and persistent under-treatment of acute pain. Even in specialized acute care like pediatric migraine management, minoritized children face significantly lower odds of receiving standard IV rescue therapies compared to non-Hispanic White children presenting with identical initial pain scores (Macias-Konstantopoulos et al., 2023; Hartford et al., 2022).
Dismissiveness directly fuels medical mistrust: A 2024 study in JAMA Health Forum examining Black patients’ experiences in the ED found that clinical dismissiveness—feeling unheard, having pain minimized, experiencing clinicians “passing them off,” and having assumptions made about their health literacy—is woven throughout emergency encounters from triage to discharge, directly confirming anticipated medical racism and driving systemic mistrust (Agarwal et al., 2024).
Twenty years of data show minimal system-level progress: The National Academies of Sciences, Engineering, and Medicine (NASEM) 2024 consensus report, Ending Unequal Treatment, confirms that despite two decades of awareness initiatives, racial and ethnic inequities in health care access, treatment quality, and clinical outcomes remain a fundamental, persistent flaw of the U.S. health care system (National Academies of Sciences, Engineering, and Medicine, 2024).
There is a profound difference between toxic compliance and assertive self-advocacy. Setting firm boundaries, correcting false medical records, and insisting that an acute physical symptom be taken seriously is not being “unkind”—it is engaging in necessary, life-preserving self-care.
What do you tell a medical provider who seems to be out of their depth or trying to rush you out the door?
Disparities across income, education, race, and ethnicity
Hoagland, Yu, and Horny (2024) examined the association between patient demographics and insurance denials for preventive care among a cohort of 1,535,181 privately insured patients seeking preventive care in the US.
What preventive care was considered in this study? Contraceptive administration, breast cancer screening, cholesterol screening, colorectal cancer screening, depression screening, diabetes screening, and wellness visits.
Here is a summary of their findings:
Patients with low incomes (<$30,000 yearly), high school degree or less, and from minoritized racial and ethnic groups experienced higher rates of claim denials. Most frequently these were noncovered service-diagnosis code pairs and billing errors. (What does this mean? People’s access to basic preventive care is different based on their demographic – or income, education, racial, and ethnic background. This is considered inequity)
Income: The lowest income group (<$30,000 yearly) had 43% higher odds of any denial than those in the highest income group (benefit denials and billing errors; statistically significant).
Race and Ethnicity:
Non-Hispanic black patients had 19% higher odds of denials compared with non-Hispanic white patients
Hispanic patients had 16% higher odds of denials compared with non-Hispanic white patients
Asian patients had 54% higher odds of denials compared with non-Hispanic white patients
Education:Differences were not statistically significant
Did practitioners resubmit bills (i.e., file the bill again) after denials?
32.4% of practitioners resubmitted the claims.
What amount was unpaid by health insurance? The mean (average) of the unpaid denied claim was $1395. This was left to patients 92.85% of the time and varied by patient income, race, and ethnicity.
Low-income patients had a higher burden than high-income patients (medians of $412 vs. $365, respectively)
Non-Hispanic black (median $390), Hispanic (median $464), and Asian (median $522) patients each facing higher costs than non-Hispanic White patients (median $357)
Smaller differences between less-educated patients (median $384) compared with those who had more education (median $399)
Financial burden for those with disabilities, chronic illness, and chronic disease
Note. I struggled to find research addressing this topic as a disparity, and I know I am not including everything out there. Please share any additional information in the comments or email me.
Below is a summary of what I found.
Increased chronic health conditions = increased financial burden. The more chronic conditions a person has is associated with an increased financial burden (i.e., increased debt, increased medical debt in collections, and increased out-of-pocket medical costs; Becker, Scott, Moniz, Carlton, & Ayanian, 2022)
Medical debt = worse population health. Medical debt is associated with worse population health (i.e., more days of poor physical and mental health, loss of years of life, higher mortality rates for all; Han, Hu, & Zheng, 2024)
Most (85%) do not file formal appeals (appeal rights vary based on coverage as do the rules; the process can be complicated)
Often those who need to appeal the health insurance decisions use a lot of health services, and may be too sick to advocate for themselves. (There are programs, Consumer Assistance Programs, available to help; however, they don’t exist in all states and Congress hasn’t appropriated funds since 2010.)
Keep in mind that most of this information describes associations between chronic conditions, medical visits, and financial burden. This means that the values of the variables (e.g., chronic health conditions and financial burden) provide information about each other. This doesn’t mean that more chronic health conditions causes more financial burden, BUT it does mean we can predict the financial burden more accurately when we know the number of chronic health conditions a person experiences.
But implementing such policies will take time and working with both State and Federal elected officials.
What can you do in the in the meantime?
Monitor your medical bills
Know your rights
Ask questions
If you don’t understand something your provider puts on a bill OR your insurance company has on the “Explanation of Benefits”, then ask. (You can even ask me)
But please don’t ignore the error. And I understand how exhausting this is. It isn’t easy. It’s frustrating. It is disheartening. It’s overwhelming.
Disclaimer. This post is not medical or legal advice. It is informational in nature with some information regarding the author’s opinion.
Leave a Reply