Each time, I hoped the next doctor might be able to help me, or at least listen to me and believe me, but instead, what I only heard was:

• “You’re being dramatic and attention seeking” “Young women experience this under stress” “It’s all in your head and you should see a psychiatrist” – illustrating the gendered and age-based dismissal and medical stigma where physical suffering is psychologized;
• “You look too healthy to be sick” – showing how chronic illness is often delegitimized when it is invisible;
• “There is nothing wrong with you since your test results are normal” “You’re too young to have angina” “You don’t match the typical profile” – exposing the systemic overreliance on narrow biomedical diagnostics and stereotypical disease profiles for under-researched or poorly understood conditions.

Honestly, I wished I were a middle-aged overweight male with a history of smoking and alcohol use, just because this would make me fit into the “box” so that they would take me more seriously. These treatments from the doctors weren’t just dismissals — they reflected gender bias and stigma that so many young women with invisible illnesses face.

Meanwhile, my symptoms grew worse and more frequent. Not being taken seriously by the doctors, I began doubting myself: What if they’re right? What if it’s all in my head? Still, I kept fighting for answers. To get a diagnosis, it required relentless self-advocacy — teaching myself to speak up, challenge my own internalized ableism, and stop doubting what I was experiencing. I had to do extensive research on my own, including reading medical journal articles, to identify possible causes of my symptoms. I then had to find doctors, convince them to believe me, and gently steer them toward running the tests I thought were necessary. Each time, I carefully guided the conversation so the doctor would agree to order the right tests — while avoiding hurting their pride. Sometimes that even meant not mentioning the name of the condition I suspected, even though my research and symptoms clearly pointed to it. If a test came back negative, I would go back to the literature, identify another possibility, and push for a different test to rule it out. Being repeatedly dismissed and gaslit left me with no other choice but to take on this role, navigating these power dynamics between patients and doctors.

Finally, one doctor suggested that I might have vasospastic angina and prescribed medication. But when it didn’t help and the diagnosis didn’t fully explain my symptoms, she wasn’t willing to investigate further — until I brought a male friend with me to the appointment. For the first time, the doctor truly listened and gave me a referral for additional testing. At the next hospital, I convinced the doctor that microvascular angina could be a possibility. He finally agreed not only to perform coronary angiography and an intracoronary acetylcholine provocation test, but also to measure Coronary Flow Reserve (CFR) and the Index of Microcirculatory Resistance (IMR) — the tests essential for an official diagnosis. When my CFR number came back abnormal, I was finally diagnosed with Microvascular Angina. The relief I felt was overwhelming: it wasn’t “all in my head” after all.

Just when I thought my fight for a diagnosis was finally over, I had to go through the same exhausting struggle again — three more times — as my other symptoms couldn’t be explained by Microvascular Angina alone. I was proven right, but it still took four years to finally get all my conditions recognized. Finally receiving a diagnosis brought relief — but it didn’t end the struggle. Beyond the physical pain, the hard part is realizing this is a chronic condition — I will have to live with it for the rest of my life. Medications don’t help, and I still face daily episodes and flare-ups, compounded by the symptoms due to other conditions I have. Alongside this reality comes a heavy emotional burden: pacing myself, challenging internalized ableism, asserting my identity and being believed, navigating my career, and grieving the life I had before getting sick. The frustrating part is, I’m full of passions and dreams to contribute to global health, yet I’m often stuck in a body that has its own limitations.

What I went through is not unique — many patients face similar struggles. This is the reality for people living with neglected non-communicable diseases (NCDs=chronic illnesses), especially young women. At the same time, my experience can be seen as a microcosm of the broader challenges in NCDs which have received limited attention in global health research and intervention. These challenges are particularly pronounced disproportionally for patients with Neglected Non-Communicable Diseases (NNCDs) and rare/invisible illnesses, patients living in low and middle-income countries (LMICs), and those with vulnerable socioeconomic status, highlighting persistent inequities in global health systems. It shows the absence of a diagnosis, which is itself a form of harm, is shaped by societal factors including structural violence, that are often overlooked in traditional public health.

The issue of delayed diagnosis is rooted in multiple systemic factors: limitations in health systems’ diagnostic pathways, gaps in research, and insufficient provider education. Patients often face stigma and stereotyping — particularly from healthcare providers — based on invisible symptoms, gender, or age, which can psychologize real physical suffering. Overreliance on biomedical diagnostics and rigid disease profiles for under-researched or poorly understood conditions further delays recognition and treatment. Power imbalances between patients and providers, combined with socioeconomic inequalities, create structural vulnerabilities, making chronic illness patients particularly subject to systemic neglect and structural violence.

This journey has shaped my passion for contributing to global health within international development, particularly in addressing chronic illnesses. Drawing on my lived experience as a patient, alongside my academic and professional expertise in Global Health, I hope to translate patients’ perspectives into meaningful insights for research, policy, and practice — ensuring that the voices of those often overlooked are heard because no patient should have to fight this hard to be believed.

Natsuko, aged 24

  Japan