Patient-centered or population-centered? How epistemic discrepancies cause harm and sow mistrust.

Medical distrust is often conceived of as a problem of misinformation or ignorance. In this paper, I depart from this framework, attributing distrust instead to epistemic divergence between lay people and experts. Using data from a contraceptive side effects Facebook group and in-depth physician interviews, I find that providers employ a "body-as-subject" lens informed by population-health goals, while group members employ a "body-as-agent" lens that privileges individuality and bodily autonomy. Provider epistemologies are privileged, creating epistemic injustice and harm for patients. Ultimately, this erodes trust in providers and the medical community more broadly. • OBGYNs take a population-centered approach to contraceptive counseling. • Dissatisfied IUD-users privilege individuality and bodily autonomy. • Failure to recognize lay epistemologies leads to epistemic injustice. • Epistemic injustice produces psychological, relational, and physical harms. • Ultimately, population-centered counseling erodes patient trust. [ABSTRACT FROM AUTHOR]