I received this book in a goodreads giveaway. I, like many others, are aware of many issues in our healthcare systems. Biases in this field are no big surprise. The author shares her heartbreaking story, and proceeds to give us the cold hard facts.

It does read as a little dry once I got into the meat of the book, but it didn't change the amount of shock I had from the information put forth. If you are at all interested into some insight in the medical field, as to how patients are perceived, and treated (especially by doctors) go ahead and give this a read. However, do take it with a grain of salt. ( )

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 ( )