difference principle & fair equality of oppurtunity - there will always be differences/inequalities in societies, but they're only fair if they help improve the lives of those off worse

can come from patient or physician

• patient - feels unheard/under pressure when seeing a doctor

• physician - patients saying unnecessary things during appointment

two subtypes: testimonial or hermeneutical

• testimonial: hearer gives less credibility to speaker's words (ex: men vs women having different pain scales, different individuals have different responses)

• hermeneutical: gap in collective interpretive resources puts someone at an unfair disadvantage in making sense of their experiences (ex: sexual harassment victims being unable to describe what happened to them, "everyone's neurodivergent" but there are certain degrees and most autistic people, for ex, were just considered a bit 'weird', ex: infants crying often & parents having to guess at why)

• ex: healthcare worker ignoring a woman crying because they assume she's a hypochondriac, or just 'emotional', or exaggerating, etc

• ex: physician not seeing a homeless person because of their bias and sees another patient instead

• geographic limitations - some places have less care available --> inaccessible care

• economic disparities (insurance coverage) - in NL, quality of healthcare that people receive is somewhat similar vs UK/US, having access to specialists is difficult, time-consuming, & usually only for wealthier people

• standardized protocol - often fail to adjust to marginalized needs of patients

  • poor vs rich americans having a wide gap in length of lifespan

• doctor puts self on higher ground than patient, "i know better", not telling patient about certain symptoms because patient will "get too emotional" or not listing all treatment options because patient "won't be able to afford it"

• medical terminology difficult to understand for average patient, then feels pressured to make choice without full scope of information

• depends on culture --> collectivistic tends to rely on doctor/not think about options themselves, "i trust that you're making the right decision for me", individualistic tends to want to make informed shared decision

• depends on interpersonal differences between doctor and patient - male/female physician vs female/male patient

• connection formed by trying to be on level ground, "i understand you, even if i'm not like you"

• most important to have understanding in a diverse population and have physicians that will understand that population