Harms, constrained agency and epistemic injustice in Australian health care: surgery involving transvaginal mesh
Mina Motamedi1, Australian Centre for Health Engagement Evidence and Values (ACHEEV),University Of Wollongong Wollongong 1Australian Centre for Health Engagement Evidence and Values (ACHEEV),University Of Wollongong, Wollongong, NSW, Australia
Abstract
Authors:
Dr Mina Motamedi
Prof Stacy M. Carter
Assoc Prof Chris Degeling
Abstract:
Transvaginal mesh (TVM) surgeries emerged as an innovative treatment for stress urine incontinency and/or pelvic organ prolapse in 1996. Years after rapid adoption of these surgeries into practice, they are a key example of worldwide failure of healthcare delivery. In Australia, as in many other countries, the prevalence of TVM-associated harms eventually prompted action, including a Commonwealth Government Senate Inquiry in 2017. We analysed submissions made by women and their advocates to the Senate Inquiry, with a focus on women’s accounts of:
a)how harms arose from TVM procedures, and
b)micro, meso and macro factors that contributed to their experience.
Our aim was to explain, from a patient perspective, how these harms persisted in Australian healthcare, and to identify mechanisms explaining the failure of healthcare system to respond to these harms.
Our study showed that women’s agency was restricted to the micro level, and that system design issues stripped women of agency and autonomy. This happened due to healthcare providers holding a privileged position in evaluation of TVM outcomes. We argue that privileging clinical perspectives over patient perspectives in evaluation of TVM outcomes subjected women to epistemic injustice, such that women’s accounts of harms had insufficient or no weight at meso and macro levels.
Establishment of system-wide expectations regarding responsiveness to patients, and communication of patient reported outcomes in evaluation of healthcare delivery, may help prevent similar failures in future.
Biography
Bio to come