Navigating Healthcare as a Woman of Color With Autoimmune Disease: Intersectional Dilemmas in Patient–Provider Interactions

Abstract

Women of color with autoimmune disease experience communicative dilemmas at the intersection of their triply minoritized (i.e., ethnic-racial, gender, and illness) identities during interactions with their healthcare providers (HCPs), which shape their care. Sensitized by intersectionality and normative rhetorical theory (NRT), the present study interrogates taken-for-granted assumptions reflected in HCPs’ communication, as recalled by 150 Black and African, Hispanic and Latina, Native American and Alaska Native, and Multiracial women of color with autoimmune disease. Using critical thematic analysis, we identify experiences of dismissal of symptoms related to autoimmune disease, illustrated through in vivo themes including (a) “another crazy woman,” (b) “assumed I was drug-seeking,” (c) “blamed it on my weight,” and (d) autoimmunity as elusive. We also identified conflicting conversational purposes, including (a) interdependent task and relational purposes, (b) the overriding salience of identity purposes, and (c) interactions with healthcare providers who shared identities with patients. We extend NRT by asserting that purposes can vary in magnitude and relevance pertaining to a given context and offer practical implications for HCPs.