Overshadowed and Overlooked

By Antonia at Unremarkable Me

Let’s start with the thing no one wants to say out loud:If you’re chronically ill, disabled, neurodivergent, or simply complicated, the NHS has a nasty habit of seeing your existing diagnosis… and deciding that’s all you’ll ever be.

It’s called diagnostic overshadowing, and it happens so often it might as well have its own NHS department. Symptoms dismissed. Concerns waved away. Pain rebranded as “probably just your usual.” It’s lazy, it’s dangerous, and it’s so baked into the system you can practically smell it in the corridors.

I’ve lived it. You’ve probably lived it. And if you haven’t? Count your blessings—and listen up, because this affects everyone who doesn’t fit the NHS’s idea of tidy, textbook health.

Overshadowing isn’t just about bias.It’s about how the system teaches itself to stop looking.It’s about what happens when medicine chooses efficiency over empathy, and certainty over curiosity.

And right now? It’s not just happening on the margins.It’s happening at scale.

What Is Diagnostic Overshadowing?

In a nutshell: it’s when your previous diagnosis becomes a filter through which all new symptoms are seen—or more accurately, ignored. Got chest pain and a history of panic attacks? “Probably anxiety.” Chronic fatigue and an autism diagnosis? “It’s behavioural.” Pain with no testable cause? “You just have a low threshold.”

The NHS Race and Health Observatory has reported widespread mistrust in NHS services among minority patients who feel constantly disbelieved or dismissed. And Engage Britain’s 2022 survey found that 1 in 5 disabled people experienced discrimination from NHS staff—often rooted in assumption rather than assessment.

The Problem Is Baked In

Bias in the NHS isn’t a glitch. It’s a design flaw that gets reinforced daily by outdated hierarchies and exhausted systems. And yes, junior doctors are caught squarely in the firing line.

In a BMJ qualitative study, clinicians admitted that time pressure, stigma, and workload led to assumptive diagnoses and shortcut reasoning—especially in A&E. The result? Patients with complex conditions are too often dismissed, sidelined, or misdiagnosed.

And if junior staff try to speak up? They’re overruled. Because if there's one thing the NHS loves more than a whiteboard full of patient names, it’s the phrase: “They’re known to us.”

Which roughly translates to: “We didn’t understand them last time and we’re not about to start now.”

But It Doesn’t Have to End This Way

Yes, the NHS has developed some policies. The NHS England Clinical Guidance now includes advice to avoid overshadowing in care of autistic people and those with learning disabilities. And the Core20PLUS5 framework identifies the most at-risk populations and focuses on tackling health inequalities.

There are toolkits and webinars. PDFs with flowcharts and laminated checklists. But you can’t fix a culture of dismissal with laminated empathy.

You fix it by making listening a clinical skill.By validating doubt instead of punishing it.And by ensuring that patients don’t have to explain—again and again—why this symptom is not that condition.

Bias Isn’t a Learning Moment. It’s a Breach of Trust.

Patients are being harmed. Not hypothetically—actually. The Patient Safety Commissioner for England, Dr. Henrietta Hughes, has stated outright that misogyny and racial bias are routinely putting patients at risk. Skin conditions missed on darker skin. Women's pain treated as emotional. Symptoms dismissed based on class, race, or previous medical history.

And when a patient dies from something preventable because no one took a second look? That’s not an unfortunate oversight. That’s a consequence of a system that rewards speed over accuracy and obedience over clinical curiosity.

Final Thoughts: Stop Training People to Ignore Us

I was once called “transparent”—as though being honest and emotionally open was a flaw. But let’s be clear: my transparency wasn’t the problem. The problem was the people who saw right through me—and then chose to look away.

So here’s the message:To NHS leadership? Stop teaching assumptions as experience.To clinicians? Question the narrative. Re-read the notes. Investigate anyway.And to patients? Don’t stop speaking just because they stopped listening.

Because bias isn’t just a learning moment. It’s a failure.And the longer we tolerate it, the more people will fall through the cracks—unseen, unheard, and untreated.

Sources & Further Reading

• LeDeR Report: Learning Disabilities and Premature Deaths

• NHS Race and Health Observatory Findings

• Dr. Henrietta Hughes on Bias in the NHS – The Guardian

• NHS England – Clinical Overshadowing Guidance

• Engage Britain – Health and Discrimination Survey

• BMJ Qualitative Study on ED Bias

• Core20PLUS5 Inequalities Framework

• Dorset NHS – Diagnostic Overshadowing Training Brief