The default patient
For most of modern medicine's history, the default research subject was a white man. Women were formally excluded from most US clinical trials until 1993. Even after inclusion, subgroup analysis by race and ethnicity often wasn't required.
The result: reference ranges, treatment protocols, and diagnostic thresholds built on a subset of the population, then applied to everyone.
What this looks like in gynae care
- Fibroids
- Black women are 2–3× more likely to develop fibroids and get them earlier, but the treatment pathway was designed around a demographic in which fibroids are rarer and later-onset.
- Endometriosis
- Historic teaching described endometriosis as a disease of 'career women' — code for white and middle-class. Diagnosis rates in Black and Asian women have been artificially low as a result.
- Maternal mortality
- In the UK, Black women are around 3× more likely to die in pregnancy and childbirth than white women (MBRRACE-UK data). Asian women around 2×.
- Pain assessment
- Multiple studies show clinicians rate the same pain as less severe in Black patients, and are less likely to prescribe adequate analgesia.
What to do with this information
This isn't a reason to distrust every clinician — plenty are excellent advocates. It's a reason to bring more evidence into the room. A written symptom log, a specific ask, and a willingness to escalate or seek a second opinion aren't rudeness — they're the workaround for a system that wasn't designed for you.