First-year obstetrics and gynaecology resident at the University of Toronto in Ontario, Canada.
First-year neurology resident at the University of Alberta in Edmonton, Canada.
AMA J Ethics. 2022 Aug 1;24(8):E740-747. doi: 10.1001/amajethics.2022.740.
Many patients face years of recurrent and debilitating menstrual pain that affects their ability to work and study. Patients often normalize their severe pain as an expected part of menses. Both underrecognition and lack of awareness of available therapies for this remediable condition serve as a quintessential example of hermeneutic injustice. Hermeneutic injustice describes a structural lack of access to epistemic resources, such as shared concepts and knowledge. Pervasive menstrual stigma further discourages people with dysmenorrhea from discussing their symptoms and seeking health care. A lack of respect for women's experiences of pain in clinical encounters acts to worsen these issues and should be considered a source of iatrogenic harm. Health care workers can promote hermeneutic justice by preemptively destigmatizing discussions about menstruation and validating patients' concerns. On a systemic level, there should be greater awareness of dysmenorrhea and the various treatments availabe for it.
许多患者都面临着多年反复发作且使人虚弱的经期疼痛，这影响了他们的工作和学习能力。患者往往将严重的疼痛视为经期的正常现象。这种可治疗的疾病既未得到充分认识，也未被人们意识到有可用的治疗方法，这是解释性不公正的典型例子。解释性不公正描述了在获取认知资源（如共享概念和知识）方面存在结构性的缺失。普遍存在的月经羞耻感进一步阻碍了经痛患者讨论其症状和寻求医疗保健。在临床接触中，不尊重女性的疼痛体验会使这些问题恶化，应将其视为医源性伤害的一个来源。医疗保健工作者可以通过预先消除对月经讨论的污名化，并确认患者的担忧来促进解释性公正。在系统层面上，应该更加了解痛经以及可用于治疗痛经的各种方法。
