This post is part of a series where I elaborate on questions I was asked after my keynote in the 13th International Shared Decision Making (ISDM) Conference, hosted at Dartmouth College, USA, July 7, 2026 to July 10, 2026. From the conference website: “With the 2026 theme, ‘A Wider Lens,’ this year’s conference will bring together clinicians, researchers, patients, and policy leaders to expand our understanding of shared decision-making across specialties, care settings, and systems.” You can find links to my recorded keynote and to the other posts in the series at the end of this post.

The question I was asked:

“I was wondering if you think epistemic injustice is hitting all patients to an equal extent, or do you think there is any (social or other) stratification in it? Or does stratification rather depend on the clinician..?”

I don’t think it’s evenly distributed at all. Health literacy, socioeconomic status, language, time, energy, and disability all shape a patient’s capacity to develop and voice this kind of knowledge. And per the four-factor framework from Part 1 of my presentation, it also depends heavily on which clinician and institution you happen to land with — so it’s stratified on both sides of the relationship. This is actually one of the open questions Chronic Knowledge is designed to investigate empirically. I’d guess the injustice compounds for patients already disadvantaged in other ways, but I don’t have the data yet.

Here are links to the other posts in this series:

• My recorded keynote for ISDM2026
• “How can we trust patients’ knowledge when there are anti-vaxxers and science deniers?”
• “What’s your opinion on healthcare delivered patient education?”
• “Who takes responsibility if the new way of taking pills harms other patients?”
• “Is epistemic injustice equally distributed, or stratified?”
• “How could we elicit Chronic Knowledge during a consultation? What question would you want to be asked?”
• “Is shared decision making ready to see the blue dots?”