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Unheard: The Medical Practice of Silencing
Have you ever felt unheard by your doctor? Been frustrated that they haven't understood your symptoms, that they have neglected your concerns?
When Dr Rageshri Dhairyawan was admitted to hospital as a patient she didn't receive the pain medication that she told them she needed, despite her having been a doctor for 20 years. It was in that moment she understood that something was deeply wrong with our healthcare system. Doctors aren't listening, and it is making us ill.
In Unheard, Dr Dhairyawan takes us on a journey through history to show how not listening to patients has been ingrained in medicine from its inception. Western medicine has been built on the assumption that power should always lie with the doctor, and that patients should be powerless to decisions made about their body if it is done to make them well. This, alongside the prejudices of society, has led to dramatic gaps in medical knowledge because for centuries people have not been heard.
Dr Dhairyawan offers a way to reshape our health system for a future where active and engaged listening is the new frontier in a timely, shocking and engaging exposé of the medical world.
When Dr Rageshri Dhairyawan was admitted to hospital as a patient she didn't receive the pain medication that she told them she needed, despite her having been a doctor for 20 years. It was in that moment she understood that something was deeply wrong with our healthcare system. Doctors aren't listening, and it is making us ill.
In Unheard, Dr Dhairyawan takes us on a journey through history to show how not listening to patients has been ingrained in medicine from its inception. Western medicine has been built on the assumption that power should always lie with the doctor, and that patients should be powerless to decisions made about their body if it is done to make them well. This, alongside the prejudices of society, has led to dramatic gaps in medical knowledge because for centuries people have not been heard.
Dr Dhairyawan offers a way to reshape our health system for a future where active and engaged listening is the new frontier in a timely, shocking and engaging exposé of the medical world.
262 pages, Kindle Edition
Published July 4, 2024
38 people are currently reading
465 people want to read
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Displaying 1 - 17 of 17 reviews
September 15, 2024
Talking to a friend about the book I was reading, I said: “Anyone who’s ever been in a hospital should read this book.” I’ve now finished reading and I fully stand by that endorsement.
In UNHEARD, Dr. Rageshri Dhairyawan unpacks the incredibly pervasive and damaging phenomenon of medical silencing. As I’m starting work on my postdoc proposal on anger and credibility of patients, coming across this book was a small miracle. If Dr. Dhairyawan hadn’t written it, I would’ve attempted to do this work in my postdoc - but now that she has, I can build on the sturdy foundations she has laid to further research the implications of epistemic injustice in healthcare.
UNHEARD is an incredible piece of work, both very readable and super thorough. Coming from a background in philosophy, I was also pleasantly surprised to find such sturdy philosophical theory woven through the book. Whether you’re a philosopher, a doctor, a patient or simply someone who has a doctor’s appointment now and then: this book is for you. Absolutely essential reading.
In UNHEARD, Dr. Rageshri Dhairyawan unpacks the incredibly pervasive and damaging phenomenon of medical silencing. As I’m starting work on my postdoc proposal on anger and credibility of patients, coming across this book was a small miracle. If Dr. Dhairyawan hadn’t written it, I would’ve attempted to do this work in my postdoc - but now that she has, I can build on the sturdy foundations she has laid to further research the implications of epistemic injustice in healthcare.
UNHEARD is an incredible piece of work, both very readable and super thorough. Coming from a background in philosophy, I was also pleasantly surprised to find such sturdy philosophical theory woven through the book. Whether you’re a philosopher, a doctor, a patient or simply someone who has a doctor’s appointment now and then: this book is for you. Absolutely essential reading.
June 10, 2024
4 Stars
As a long term patient of chronic illness, I have suffered a lot of silencing or ignoring from medical professionals in my life. I suffer from endometriosis which the author of this book also suffers from. It is a disease that is drastically underfunded and has a huge lack of knowledge or research. Because of this, medical professionals often put my illness down as "a bad period" or have thought I was exaggerating the daily pain I felt. It took me nearly 8 years of continually trying to find a diagnosis and seeing tons of doctors to finally be diagnosed with endometriosis. This was because one GP FINALLY listened properly to me and had the knowledge to send me to an endometriosis centre for surgery. All this happened despite at the age of 17, at my first GP appointment about this issue I asked my GP "could I have endometriosis?" and she replied that I was too young (I wasn't).
Now, 11 years on from diagnosis I have had 7 surgeries for endometriosis and an uncountable number of treatments including being put into a medically induced menopause. I am lucky to be a white, straight, well educated woman as there is a huge difference in the way women of colour and those in the LGBTQ+ community are treated.
I have told you my story and background because it is important to know just why I was so excited and also worried to read this book. I knew the "medical practice of silencing" was bad from my own experiences but I could never imagine just how bad it can be for others.
Dr Rageshri Dhairyawan is the author of this book, she suffers from endometriosis and is a lead doctor in HIV/AIDS. This book does massively focus on HIV as a result and although I wish it had included more varied diseases/illnesses, it was hugely interesting to hear in detail about her experience and case studies of her patients within this field.
The book is split up into 7 chapters including "Dismissed", "Devalued" and "Roar" which were my favourite chapters to read. Overall the book was split up and looked into this important issue incredibly well. I do think it would be a tough book for a lot of people to read, however. The writing is very dense and reads more like a medical journal than a medical book. I felt the writing and the way the book is presented need to be changed to be more accessible, however I did receive an early Uncorrected Manuscript Copy so hopefully the final book isn't quite so dense. There is also a lot of repetition and I think it needed a decent edit.
Despite this, the information is very interesting and I found myself incredibly engaged for a lot of the book and got emotional during reading some of the facts and figures on the dangers of medical silencing as well as the case studies included. It is incredibly well researched and a lot of time and effort has gone into matching case studies with facts and historical information.
Overall, I definitely would recommend this book but would warn that it is a dense read. I have learnt a lot and I haven't seen any books out on this subject so I applaud the author for tackling this tough subject, especially as a working Doctor. I am very glad I read this book!
Please note that I was given this book in exchange for an honest review.
As a long term patient of chronic illness, I have suffered a lot of silencing or ignoring from medical professionals in my life. I suffer from endometriosis which the author of this book also suffers from. It is a disease that is drastically underfunded and has a huge lack of knowledge or research. Because of this, medical professionals often put my illness down as "a bad period" or have thought I was exaggerating the daily pain I felt. It took me nearly 8 years of continually trying to find a diagnosis and seeing tons of doctors to finally be diagnosed with endometriosis. This was because one GP FINALLY listened properly to me and had the knowledge to send me to an endometriosis centre for surgery. All this happened despite at the age of 17, at my first GP appointment about this issue I asked my GP "could I have endometriosis?" and she replied that I was too young (I wasn't).
Now, 11 years on from diagnosis I have had 7 surgeries for endometriosis and an uncountable number of treatments including being put into a medically induced menopause. I am lucky to be a white, straight, well educated woman as there is a huge difference in the way women of colour and those in the LGBTQ+ community are treated.
I have told you my story and background because it is important to know just why I was so excited and also worried to read this book. I knew the "medical practice of silencing" was bad from my own experiences but I could never imagine just how bad it can be for others.
Dr Rageshri Dhairyawan is the author of this book, she suffers from endometriosis and is a lead doctor in HIV/AIDS. This book does massively focus on HIV as a result and although I wish it had included more varied diseases/illnesses, it was hugely interesting to hear in detail about her experience and case studies of her patients within this field.
The book is split up into 7 chapters including "Dismissed", "Devalued" and "Roar" which were my favourite chapters to read. Overall the book was split up and looked into this important issue incredibly well. I do think it would be a tough book for a lot of people to read, however. The writing is very dense and reads more like a medical journal than a medical book. I felt the writing and the way the book is presented need to be changed to be more accessible, however I did receive an early Uncorrected Manuscript Copy so hopefully the final book isn't quite so dense. There is also a lot of repetition and I think it needed a decent edit.
Despite this, the information is very interesting and I found myself incredibly engaged for a lot of the book and got emotional during reading some of the facts and figures on the dangers of medical silencing as well as the case studies included. It is incredibly well researched and a lot of time and effort has gone into matching case studies with facts and historical information.
Overall, I definitely would recommend this book but would warn that it is a dense read. I have learnt a lot and I haven't seen any books out on this subject so I applaud the author for tackling this tough subject, especially as a working Doctor. I am very glad I read this book!
Please note that I was given this book in exchange for an honest review.
January 23, 2025
A very thoughtful, well researched and accessible book about an issue that is incredibly pervasive in healthcare and yet rarely discussed.
It is written largely about medical doctors but the majority is applicable to all areas of healthcare, including patients. It has definitely helped me develop some of my thinking in this area and will hopefully improve my practice. Very worthwhile read.
It is written largely about medical doctors but the majority is applicable to all areas of healthcare, including patients. It has definitely helped me develop some of my thinking in this area and will hopefully improve my practice. Very worthwhile read.
September 28, 2024
Dr Rageshri Dhairyawan pulls on her experience as a HIV doctor and a patient with endometriosis to write the fantastic book about how patients are not heard by doctors and about how certain doctors are not heard by the white heteropatriarchal establishment. The result is fantastic!
The way she writes is brilliant too, with narrative scenarios (narrative non fiction) being set up to illustrate the points she wants to make, followed by a summary of her research into the topic and personal experience and finally a bulletpoint summary of the issues she discussed in each chapter.
In the first chapter, she explores how patients are silences, the concepts of testimonial injustice, hermeneutical injustice, testimonial smothering and how these lead to patients being ignored as they are viewed as “untrustworthy and unable to be objective about their own illness.”
In the next chapter she looks at why doctors don’t listen to patients, including how medical school creates the feeling they are exceptional, how medical stidents loose their empathy during medical school and how all their training is for the ideal patient, who does not exists. She then explores ways that patients and doctors can work on their communication skills to better hesr each other.
In the next chapters, she explores racism and sexism in the doctor profession lead to certain voices and the diseases and patients they champion being ignored and excluded, and how this creates a knowledge gap around certain illnesses that affect women or people of colour with higher percentages than white men. She explains that part of the reason responses to covid were so fast, was that it had the right patients - white men. She also explores the colonial legacy behind global health and the way western medicine is rolled across the Global South with a broad and violent brush and local knowledge is ignored.
“I count myself lucky - my diagnosis only took two years. The average time to an endometriosis diagnosis in the UK is eight years, a wait so long I feel furious just writing it.' I went to my GP and my concerns were taken seriously; my doctor privilege meant that my symptoms were believed. I knew what language I needed to use to get the tests and referrals I needed. In a way, I was the 'ideal patient that I discuss in Chapter 2, describing a medical history that 'fit' the possible diagnosis of endometriosis. But why did it take a chance hearing about endometriosis for me to think about it? Why didn't my GP or I suspect endometriosis sooner, before it become so advanced?”
While the whole book was fantastic, my favourite chapter was Chapter 5: Objective: What Counts As Medical Evidence. It explores what kind of evidence is taken seriously in medical research and who is allowed to provide it. Patient knowledge and experience is undervalued compared to research produced at universities. In writing this chapter she draws on her own experience as a patient, medical history, the comcept of disease prestige - where visible and life threatending diseases are valued more and taken more seriously than chronic diseases with slow recovery and few objective signs or diagnostic criteria, and the legacy of large sclae medical trials that were unethically done using enslaved subjects.
In the two final chapters, she explores the HIV epidemic and how activists managed to get the patient voice heard and legislations changed and how to be an effective listener - manly based on her experiences speaking up for people of colour at medical conferences and in her conversations with patients as a HIV doctor.
Taken together this book combines narrative non fiction, the authors experiences, medical knowledge, medical history and studies into racism and sexism in medicine and patient care. Utterly fantastic and a refreshing read. Also, as this topic interests me, I have read almost all the books she references in this book and 1) they are excellent books and 2) she adds so much to their conversation in this book!
The way she writes is brilliant too, with narrative scenarios (narrative non fiction) being set up to illustrate the points she wants to make, followed by a summary of her research into the topic and personal experience and finally a bulletpoint summary of the issues she discussed in each chapter.
In the first chapter, she explores how patients are silences, the concepts of testimonial injustice, hermeneutical injustice, testimonial smothering and how these lead to patients being ignored as they are viewed as “untrustworthy and unable to be objective about their own illness.”
In the next chapter she looks at why doctors don’t listen to patients, including how medical school creates the feeling they are exceptional, how medical stidents loose their empathy during medical school and how all their training is for the ideal patient, who does not exists. She then explores ways that patients and doctors can work on their communication skills to better hesr each other.
In the next chapters, she explores racism and sexism in the doctor profession lead to certain voices and the diseases and patients they champion being ignored and excluded, and how this creates a knowledge gap around certain illnesses that affect women or people of colour with higher percentages than white men. She explains that part of the reason responses to covid were so fast, was that it had the right patients - white men. She also explores the colonial legacy behind global health and the way western medicine is rolled across the Global South with a broad and violent brush and local knowledge is ignored.
“I count myself lucky - my diagnosis only took two years. The average time to an endometriosis diagnosis in the UK is eight years, a wait so long I feel furious just writing it.' I went to my GP and my concerns were taken seriously; my doctor privilege meant that my symptoms were believed. I knew what language I needed to use to get the tests and referrals I needed. In a way, I was the 'ideal patient that I discuss in Chapter 2, describing a medical history that 'fit' the possible diagnosis of endometriosis. But why did it take a chance hearing about endometriosis for me to think about it? Why didn't my GP or I suspect endometriosis sooner, before it become so advanced?”
While the whole book was fantastic, my favourite chapter was Chapter 5: Objective: What Counts As Medical Evidence. It explores what kind of evidence is taken seriously in medical research and who is allowed to provide it. Patient knowledge and experience is undervalued compared to research produced at universities. In writing this chapter she draws on her own experience as a patient, medical history, the comcept of disease prestige - where visible and life threatending diseases are valued more and taken more seriously than chronic diseases with slow recovery and few objective signs or diagnostic criteria, and the legacy of large sclae medical trials that were unethically done using enslaved subjects.
In the two final chapters, she explores the HIV epidemic and how activists managed to get the patient voice heard and legislations changed and how to be an effective listener - manly based on her experiences speaking up for people of colour at medical conferences and in her conversations with patients as a HIV doctor.
Taken together this book combines narrative non fiction, the authors experiences, medical knowledge, medical history and studies into racism and sexism in medicine and patient care. Utterly fantastic and a refreshing read. Also, as this topic interests me, I have read almost all the books she references in this book and 1) they are excellent books and 2) she adds so much to their conversation in this book!
September 1, 2024
This is an important book for all of us working in healthcare. It is the reflections and shared understanding of a mid-career Physician who has also been at the receiving end of healthcare. Rageshri talks about the medical practice of silencing, of not listening to the patient, especially when the power imbalance is greater. She centres this around the concept of epistemic injustice, patients not being recognised as 'knowers'. She talks about Miranda Fricker's description of two kinds of epistemic injustice: testimonial injustice (not believing) and hermeneutical injustice (not being able to interpret). She offers many other areas of thought throughout the book: patient consultations which may be transactional and relationship- based, the role of humanities and what we may learn from wider human understanding, balancing evidence-based medicine with compassion and care, understanding equality beyond representation and the myth of objectivity. While I have understood some of this in my journey as a physician increasingly understanding and aspiring to provide a bio-psycho-social model, this book offers me the language to articulate the thought and communicate it to those I deliver care and those who work with me. We need much humility and the ability to live with less certainty about our own knowledge to not be silencers.
The audible books is read by the author, and read very well.
The audible books is read by the author, and read very well.
September 27, 2024
As a novice researcher in social science and healthcare inequality, I was drawn to this book through recommendations from several colleagues. It proved to be both accessible and engaging, making complex ideas approachable for readers. While some of the concepts were familiar from my prior reading, the book introduced me to many significant practices that were entirely new to me.
A few examples that resonated with me:
- The depiction of how many minoritised patients modify their appearance and speech in medical settings to increase their credibility and improve their chances of being taken seriously by healthcare professionals.
- The contrast between transactional models of medicine and more holistic, relationship-based approaches to care.
- I had encountered the concept of epistemic injustice before, but Dr. Dhairyawan’s exploration of epistemic exclusion and epistemic oppression deepened my understanding significantly.
- The idea of "disease prestige" was completely new to me, yet it has helped me identify some of the unspoken hierarchies and dynamics within my own medical specialty.
I would highly recommend this book to anyone seeking to better understand the oppressive and exclusionary structures embedded in modern healthcare. It offers valuable insights for those of us working to address inequality and improve patient care.
A few examples that resonated with me:
- The depiction of how many minoritised patients modify their appearance and speech in medical settings to increase their credibility and improve their chances of being taken seriously by healthcare professionals.
- The contrast between transactional models of medicine and more holistic, relationship-based approaches to care.
- I had encountered the concept of epistemic injustice before, but Dr. Dhairyawan’s exploration of epistemic exclusion and epistemic oppression deepened my understanding significantly.
- The idea of "disease prestige" was completely new to me, yet it has helped me identify some of the unspoken hierarchies and dynamics within my own medical specialty.
I would highly recommend this book to anyone seeking to better understand the oppressive and exclusionary structures embedded in modern healthcare. It offers valuable insights for those of us working to address inequality and improve patient care.
July 11, 2025
This is a really important book. It challenges everything we have taken for granted about the teaching and practice of medicine as well as presenting well balanced arguments around evidence based medicine and research practices as well as patient representation. The chapters are well organised with a real life example laying the foundation for evidenced arguments and finishing with practical summary points. A very fine piece of work. The only problem is that as a medical practitioner myself it has left me feeling overwhelmed. I can certainly identify instances in my own practice when I have been guilty of silencing and Dhairyawan presents the barriers to better practice eloquently. The book has certainly made me more alert to the problem and makes me want to do better, but I fear that the environment I work in as part of the NHS and even down to the evidence I use to help me make decisions in patient care probably means that I will continue to be guilty of silencing at points in the future. I can only hope that with increased awareness, while I might not be perfect I can at least carry on improving.
March 20, 2025
A definite must read for clinicians and a source for a lot of food for thought. I have a lot of feelings, mainly around feeling listened and understood when reading this, I nearly cried in a public setting when reading it many times.
My only small plea for editing for the next edit would be to amend saying that European countries colonised other countries - whilst this is true, it gives those that don’t have intrinsic european history knowledge the impression that we’re all privileged and colonisers, which is far from the truth (my home country was colonised by 3 Empires repeatedly, and we’re v marginalised within the European ladder, fact that is very much dismissed by those that are not exposed to this or have internal awareness of this)
My only small plea for editing for the next edit would be to amend saying that European countries colonised other countries - whilst this is true, it gives those that don’t have intrinsic european history knowledge the impression that we’re all privileged and colonisers, which is far from the truth (my home country was colonised by 3 Empires repeatedly, and we’re v marginalised within the European ladder, fact that is very much dismissed by those that are not exposed to this or have internal awareness of this)
July 17, 2024
Incisively written and horribly compelling, this sharp and timely book gives readers an insight into the hidden mechanisms that function in healthcare. Dhairyawan unpicks the legacies of colonialism and the impact of white supremacy within our healthcare practices to explain gross inequities in treatment – inequities that typically fall along racialised or gendered lines. Whether you're a patient, a medic, or both, this book will help you understand your own and other people's experiences of a system that all too often privileges certain bodies over others.
October 8, 2024
A fascinating, eye-opening look at different types of silencing and inequalities in healthcare, past and present, their origins and terrible impacts. There are stories and statistics in here that we should all know, and focused, practical advice for what we can all do to challenge injustice and help create more equitable care. This is a book for everyone, with vital lessons to be carried to all settings.
June 10, 2025
This is a book that is not just for clinicians to read. I read it to feel solidarity with the downtrodden but ended up having my eyes opened to how I see the world and how easy it is to form opinions (right/wrong) we all need to be open and listen (really listen to eachother). Honestly a read for EVERYONE👍
January 3, 2025
this book changed my life. articulated so many things that are always on my mind as a medical student and yet i never find the words for. probably the best medical book i’ve ever read, and should be on the medical curriculum. i want to be dr dhairyawan when i grow up.
July 13, 2024
Such an important and really well researched book.
August 3, 2024
An effective drawing together of existing strands on dignity in UK medical care and research, underpinned by deep personal experience.
October 26, 2024
4.5⭐️
A thought-provoking read, incredibly important and timely.
A thought-provoking read, incredibly important and timely.
September 1, 2025
A difficult read but important
September 14, 2024
This felt like a very important book while I was reading it. From a patient perspective, it was extremely validating and informative. It should probably be made into a compulsory text for any aspiring healthcare worker.
It would have been nice to read more about patients with ME/CFS and long covid, but I think that the topics covered in the book felt relevant enough to apply to the lived experiences of any patient.
If you’ve been ignored or dismissed while seeking medical care, this book will help you realise why. If you’re a doctor who thinks this probably doesn’t apply to you, then you should definitely read it, you might learn a thing or two.
It would have been nice to read more about patients with ME/CFS and long covid, but I think that the topics covered in the book felt relevant enough to apply to the lived experiences of any patient.
If you’ve been ignored or dismissed while seeking medical care, this book will help you realise why. If you’re a doctor who thinks this probably doesn’t apply to you, then you should definitely read it, you might learn a thing or two.
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