Pride and Prognosis

This year, my family and I celebrated Mother’s Day with very special news: my mother’s cancer diagnosis. I use that colon ironically because she was diagnosed with colon cancer. As I traced the events that led up to her diagnosis, I realized the hypocrisy of our preventative care system.

Two years ago, my mother requested a colonoscopy from her family doctor. It is recommended for people to begin screening for colorectal cancer at the age of 45, and even earlier for those with a family history or certain genetic syndromes. Being 52 and having lost both her parents and her maternal aunt to cancer, she had hoped to take a proactive step toward prevention. But her doctor dismissed her request. Her stool test results were normal, he said. No further screening needed.

Stool tests are quick and efficient but are less sensitive at detecting precancerous polyps. If abnormalities are found, additional tests may be ordered, but by that point, the polyps have already grown large enough to cause bleeding—often a sign that cancer has begun to develop.

On the other hand, colonoscopies, although more expensive, are considered the gold standard for colorectal cancer screening because they’re both diagnostic and preventive. If a polyp is found during the procedure, it can be removed immediately and sent for biopsy—eliminating the delay between detection and action. Unlike stool tests, colonoscopies don't wait for signs of cancer to emerge. They help stop it before it even starts.

Two years later, my mother completed another one of her annual stool tests. This time, blood was detected in her stool. She was called back in for the colonoscopy she had requested two years ago. During the procedure, the doctors removed a polyp for biopsy. About a week later, the results came in—the big C. A week after that, my mother had to meet with a surgeon. And three weeks later, my mother would undergo surgery to remove the tumor that, turns out, had already grown to stage IIa.

For recently diagnosed patients like my mother, what can be even more painful and excruciating than the cancer itself is the waiting—waiting for the results, waiting for the unknown, waiting for death. Late at night, unable to sleep, my mother would sit up in her bed with her reading glasses on, scrolling through articles about colorectal cancer, other cancers, cancer-fighting foods, chemotherapy, hair loss. She read until her eyes dried and only then, worn out by fear and anxiety, would she be granted a few hours of sleep.

In moments like this, patients are taught to trust their lives in their physician’s hands. But those same hands waved my mother’s concerns away. Maybe it was her accented English. Or maybe it was because she’s a woman. Or maybe because the doctor thought her insurance wouldn’t cover the colonoscopy. Biases like these, implicit and explicit, are not uncommon, especially for vulnerable and marginalized patient populations like females, ethnic minorities, older adults, LGBTQ individuals, and psychiatric patients.

For instance, chronic pain in older adults may be dismissed as a “natural part of aging.” Additionally, women have been documented to receive less comprehensive treatment than men. This in part is because their symptoms are more likely to be downplayed due to harmful stereotypical perceptions that women are more emotional and dramatic. Physicians also tend less to the negative experiences of Black and Asian patients than White patients. Compounding these interpersonal biases are systemic factors like insurance status. Studies show that physicians often alter their clinical decisions when patients lack adequate insurance, even withholding referrals for colonoscopies or smoking cessation medications. The recent passage of the so-called “Big Beautiful Bill” will slash Medicaid funding by $930 billion over the next decade, making preventative care even less accessible to people who need it most. When these factors intersect, they create the ideal conditions for medical gaslighting, where patients’ clinical concerns are dismissed or invalidated by their attending physician.

In many situations, clinical decision making is not driven by the patient’s symptoms or needs but rather by the physician’s biases and structural constraints. Like in my mother’s case, we don’t blame her physician—not for the shed tears or the sleepless nights or even the cancer. But rather, the system that trains doctors to dismiss rather than listen and to prioritize profit over people. Patients shouldn’t have to speak perfect English, know the correct medical terms, or have a premium insurance plan to be taken seriously. We need to train healthcare professionals in cultural humility and competency.

Doctors have told my mother she’s so lucky they caught the cancer early. She only has to perform a simple surgery that removes the entire right side of her colon. The tumor didn’t spread to any lymph nodes, but it maybe-sort-of invaded her nerve tracts so now there’s a slightly higher risk of recurrence. Because of that, she only has to take 8 cycles of chemotherapy (only 24 weeks!). During her treatment, she only has to quit her job for half a year. Fortunately, the drug won’t cause hair loss, just diarrhea, nausea, vomiting, mouth sores, throat sores, and loss of appetite. The doctors are right—it could be so much worse. But it could also be so much better. And if we use “luck” as an excuse for doctor’s neglect, we will keep mistaking preventable suffering for acceptable outcomes. After all, what is the point of providing preventative care if it’s not, you know, preventing?

Throughout their medical training, physicians are trained to answer a million rapid-fire, carefully crafted questions from medical experts. But when they are asked a question from patients—especially from those not equipped with a command of clinical terminology or the prestige of a white coat—they sometimes forget that uncertainty doesn’t make their question any less valid.

Shawn Tran is a Sacramento native whose work explores themes of culture and relationships. As an introvert, he finds his voice through writing. His work can be found in The New York Times, The Chicago Tribune, The Wall Street Journal, and Mud Season Review.