Beyond Blood: How the Intersectionality of Gender and Race Contributed to a Delayed Diagnosis

Jane is a 2-year-old Black girl who presented to the emergency department after lacerating her tongue while jumping on a trampoline. She was seen several times before this encounter for previous lacerations, episodes of epistaxis, and severe ecchymoses, all of which were not completely investigated. Despite her fragmentary treatment, Jane's parents continued to advocate for her health by raising concerns to providers in the hopes of determining the cause of her recurrent bleeding; however, these concerns were often dismissed and absent from documentation. Although Jane presented to many different providers, rendering her multiple opportunities for diagnosis, her medical history was not completely explored and her care was discontinuous, resulting in a delayed diagnosis of von Willebrand disease. Jane's story brings attention to the intersectionality of health disparities and the discrimination that persists in the medical system. Her delayed diagnosis represents many others who have also been inadequately treated based on their race, gender, or socioeconomic status, and provides an opportunity to uncover where the medical system falters. Jane's story opens the discussion about (1) racism as it exists systemically, historically, and within medicine; (2) the intersectionality of gender and race, as well as the place this holds in medicine; (3) the clinical factors leading to her missed diagnosis; and (4) future strategies proposed to mitigate racism's role in medicine.