Whose pain is taken seriously? linguistic credibility, gendered expression, and diagnostic inequality in Indonesian clinical encounters
DOI:
https://doi.org/10.67490/ijml.v1i2.947Keywords:
clinical communication, diagnostic inequality, gendered pain, language justice, linguistic credibilityAbstract
Background: Pain credibility in clinical encounters is often shaped by language, gendered expectations, and diagnostic uncertainty, making unequal recognition of suffering a communicative as well as biomedical problem. Objective: This study examines how Indonesian public clinical communication frames pain as credible, doubtful, ordinary, urgent, or diagnostically actionable. Method: Using a corpus-assisted discourse-pragmatic design, this study analyses 25 deduplicated public documents from national health institutions, hospital sources, public campaigns, and media texts through linguistic credibility analysis, a gendered pain legitimacy matrix, and a clinical communication and language-justice audit. Results: Pain was most frequently legitimised through communication contexts, symptom recognition, treatment pathways, service access, and warning-sign language. Gendered pain gained seriousness mainly when attached to reproductive, menstrual, pelvic, sexual, fertility, or screening-related categories, indicating that women’s pain was recognised through specific biomedical thresholds rather than through gender-neutral suffering. Implication: Language access, plain explanation, informed consent, patient rights, listening, and diagnostic safety emerged as conditions through which pain testimony became clinically intelligible and actionable. Novelty: This study contributes by repositioning diagnostic inequality in pain care as an epistemic and linguistic process in which credibility, gendered expression, and communicative access jointly shape whose pain is taken seriously within Indonesian healthcare communication and patient-safety discourse contexts
Downloads
References
[1] eClinicalMedicine, “Gendered pain: A call for recognition and health equity,” eClinicalMedicine, 69, 2024, doi: 10.1016/j.eclinm.2024.102558.
[2] L. Zhang, E. Losin, Y. K. Ashar, L. Koban, and T. Wager, “Gender biases in estimation of others’ pain,” The Journal of Pain, 22, 1048–1059, 2021, doi: 10.1016/j.jpain.2021.03.001.
[3] S. Choshen-Hillel, M. Guzikevits, A. Perry, A. Gileles-Hillel, and T. Gordon-Hecker, “Sex bias in pain management decisions,” Proceedings of the National Academy of Sciences of the United States of America, 121, 2024, doi: 10.1073/pnas.2401331121.
[4] M. Patrick-Smith and S. Bull, “Medical student perceptions of gender and pain: A systematic review of the literature,” BMC Medicine, 22, 2024, doi: 10.1186/s12916-024-03660-0.
[5] M. Dudley, R. E. Olson, K. Mescouto, and J. Setchell, “The good pain patient: A critical evaluation of patients’ self-presentations in specialist pain clinics,” Health Sociology Review, 33, 306–324, 2024, doi: 10.1080/14461242.2024.2350501.
[6] E. Hintz, “‘It’s all in your head’: A meta-synthesis of qualitative research about disenfranchising talk experienced by female patients with chronic overlapping pain conditions,” Health Communication, 38, 2501–2515, 2022, doi: 10.1080/10410236.2022.2081046.
[7] M. Beach, S. Saha, J. Park, J. L. Taylor, P. Drew, E. Plank, L. Cooper, and B. Chee, “Testimonial injustice: Linguistic bias in the medical records of Black patients and women,” Journal of General Internal Medicine, 36, 1708–1714, 2021, doi: 10.1007/s11606-021-06682-z.
[8] M. Tosàs, “The downgrading of pain sufferers’ credibility,” Philosophy, Ethics, and Humanities in Medicine, 16, 2021, doi: 10.1186/s13010-021-00105-x.
[9] S. E. Bigger, D. Obregon, C. Keinath, and K. Doyon, “Language justice as health equity in palliative care: A scoping review,” Journal of Pain and Symptom Management, 69, 269–288, 2024, doi: 10.1016/j.jpainsymman.2024.11.012.
[10] P. S. Lim, M. Fortier, and Z. Kain, “Pain disparities attributed to linguistic minoritization in health care settings,” The Journal of Pain, 37(Suppl.), 104688, 2024, doi: 10.1016/j.jpain.2024.104688.
[11] I. A. Scott, J. A. Doust, G. Keijzers, and K. Wallis, “Coping with uncertainty in clinical practice: A narrative review,” Medical Journal of Australia, 218, 2023, doi: 10.5694/mja2.51925.
[12] K. S. Indriani, “Communication strategies in a medical setting: Overcoming language barriers at the pain clinic of RSUD Genteng Banyuwangi,” International Journal of Multilingual Education and Applied Linguistics, 2025, doi: 10.61132/ijmeal.v2i2.339.
[13] M. Nurtyas, “Language barriers in healthcare delivery: A sociolinguistic case study of multilingual patients in Indonesian urban clinics,” Indonesian Journal of Medical Linguistics, 1(1), 26–38, 2026.
[14] R. Ritunnano, “Overcoming hermeneutical injustice in mental health: A role for critical phenomenology,” Journal of the British Society for Phenomenology, 53, 243–260, 2022, doi: 10.1080/00071773.2022.2031234.
[15] M. Healy, A. Richard, and K. Kidia, “How to reduce stigma and bias in clinical communication: A narrative review,” Journal of General Internal Medicine, 37, 2533–2540, 2022, doi: 10.1007/s11606-022-07609-y.
[16] M. Beach, K. Harrigian, B. Chee, A. Ahmad, A. Links, A. Zirikly, et al., “Racial bias in clinician assessment of patient credibility: Evidence from electronic health records,” PLOS ONE, 20, 2025, doi: 10.1371/journal.pone.0328134.
[17] B. Boring, K. Walsh, N. Nanavaty, B. W. Ng, and V. Mathur, “How and why patient concerns influence pain reporting: A qualitative analysis of personal accounts and perceptions of others’ use of numerical pain scales,” Frontiers in Psychology, 12, 2021, doi: 10.3389/fpsyg.2021.663890.
[18] K. Harrilal-Maharaj, “Gender bias and diagnostic delays in young women: A narrative review,” Cureus, 17, 2025, doi: 10.7759/cureus.100004.
[19] A. Peiró, P. Carracedo, L. Agulló, and S. F. Bernardes, “Gendered dimension of chronic pain patients with low and middle income: A text mining analysis,” PLOS ONE, 19, 2024, doi: 10.1371/journal.pone.0311292.
[20] A. Vetterlein, M. Reuter, L. Von Häfen, S. Dressler, and T. Plieger, “The influence of sex and gender, gender ontological beliefs, and sexism on pain sensitivity judgments: Implications for health care settings and beyond,” Gender Issues, 41, 2024, doi: 10.1007/s12147-024-09332-w.
[21] G. Puto, I. Repka, and A. Gniadek, “Gender differences in the quantitative and qualitative assessment of chronic pain among older people,” Frontiers in Public Health, 12, 2024, doi: 10.3389/fpubh.2024.1344381.
[22] M. A. Ruben and M. D. Stosic, “Documenting race and gender biases in pain assessment and a novel intervention designed to reduce biases,” The Journal of Pain, 25, 104550, 2024, doi: 10.1016/j.jpain.2024.104550.
[23] A. Böthun, A. Fjellman-Wiklund, F. Hellström, B. Stålnacke, B. Häggman-Henrikson, J. Durham, and A. Lövgren, “Intersectional bias in healthcare—The inequity borne by the patients: A qualitative study,” Journal of Oral Rehabilitation, 53, 328–336, 2025, doi: 10.1111/joor.70088.
[24] M. Dahm, W. Cattanach, M. Williams, J. M. Basseal, K. Gleason, and C. Crock, “Communication of diagnostic uncertainty in primary care and its impact on patient experience: An integrative systematic review,” Journal of General Internal Medicine, 38, 738–754, 2022, doi: 10.1007/s11606-022-07768-y.
[25] S. Jala, M. Fry, and R. M. Elliott, “Cognitive bias during clinical decision-making and its influence on patient outcomes in the emergency department: A scoping review,” Journal of Clinical Nursing, 2023, doi: 10.1111/jocn.16845.
[26] A. J. Neville, I. Clemente, M. Meldrum, L. Zeltzer, A. Jordan, T. F. Oberlander, et al., “How the clinical encounter shapes diagnostic uncertainty in pediatric chronic pain,” The Journal of Pain, 32, 105406, 2025, doi: 10.1016/j.jpain.2025.105406.
[27] R. White, R. Fay, A. Chiumento, C. Giurgi-Oncu, and A. Phipps, “Communication about distress and well-being: Epistemic and ethical considerations,” Transcultural Psychiatry, 59, 413–424, 2022, doi: 10.1177/13634615221082795.
[28] N. Laila, “Medical jargon and patient comprehension: A linguistic analysis of informed consent practices in Indonesian hospitals,” Indonesian Journal of Medical Linguistics, 1(1), 13–25, 2026.
[29] I. L. Nazulpa, “Doctor–patient communication in rural Indonesia: A pragmatic study of directive speech acts in clinical consultations,” Indonesian Journal of Medical Linguistics, 1(1), 1–12, 2026.
[30] Y. D. Rusita, “Constructing empathy through language: A linguistic perspective on compassionate communication in mental health services,” Indonesian Journal of Medical Linguistics, 1(1), 67–81, 2026.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Sri Astutik Andayani (Author)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Creative Commons Attribution 4.0 International License