“No, this is not all in my head!” A Lesson on Medical Gaslighting
At the request of my specialist, I'm walking down the hallway outside of the exam room. The physician is watching me walk away, turn around and walk back toward him.
“I don’t see anything conclusive. You appear to have a normal gait. When did you say this happens?”
“Well usually when I reach the high intensity part of my workout.” …………
And now, the long silence; I’m sure I can read the look on the physician’s face as if to say, ‘Well then, don’t do that.”
Instead, he says, “Have you been under a lot of stress lately?”. Ahh… There it is, attributing my toes involuntary curling in my shoe as due to stress. I stop and for a split moment, think to myself, ‘Have I been stressed lately?’ Yes. Yes, I have because no one can figure out why my toes curl in my shoe!!! Could this be Medical Gaslighting?
What is Medical Gaslighting?
Medical gaslighting occurs when health care professionals downplay or disregard a patient’s symptoms. This can happen in various forms; the provider may suggest a physical symptom is due to psychological factors or may figuratively or physically walk away from the patient dismissing both the patient and their reported symptoms as not real.
Effects of Medical Gaslighting
Over time, medical gaslighting causes patients to begin to doubt themselves and their perception of reality. They begin to wonder if indeed they are imagining the symptom or problem. They become less confident in their judgement and hence, they become less active in initiating care or making healthcare decisions. At the very least, patients become frustrated and distrustful of the healthcare system.
The consequences of medical gaslighting are profound. Patients subjected to medical gaslighting experience worsening health as they are often left with improper or inadequate treatment and misdiagnosis.
Why is This Happening?
Persons at greater risk of medical gaslighting include women, the elderly, people of color, the poor and those with chronic illnesses.
Medical gaslighting can be conscious or subconscious behavior on the part of the medical provider. Factors can be cultural knowledge deficit, unconscious bias, lack of experience of the provider, lack of empathy, lack of time/resources to think critically,environmental stressors, or provider narcissism. One expert in this field suggests that healthcare providers lacking experience with the patient’s problem or an inability to give answers to the patient may precipitate dismissing the complaint or gaslighting behavior. The theory is that the provider fears failing the patient. They verbally and often physically separate themselves from the patient.
On the other hand, a practitioner who is confident with their skills behaves quite differently; they ‘lean in’ to the patient or, physically get closer as they want to learn more.
How to Recognize Medical Gaslighting
The doctor is:
- not engaged in the conversation; they are focused on their electronic device with an occasional,” Uh huh”; generally, not making eye contact.
- not writing down your concerns or probing further.
- frequently interrupting or shutting down your complaints or concerns.
- blaming you for your symptoms such as obesity, stress from work, lack of exercise, etc.
- Forcing a reciprocal response; you find yourself raising your voice, forcing you to argue, to be heard and taken seriously.
- putting up roadblocks to placing a referral for services or making excuses why they can't give one.
- trying to convince you it's all in your head.
How to Combat Medical Gaslighting
- Start by obtaining copies of your medical records. Every patient has the right to obtain a copy of their medical records. Look for omissions, impressions, or inaccurate documentation.
- Journal your symptoms. Document dates, times, the intensity of your symptoms, take photos of clinical symptoms and any other relevant details. This record can provide a clear picture of what you are experiencing, potential causes, etc. Take this with you to your physician appointment.
- Prepare a list of questions you want answered and take with you to the provider appointment. This increases the likelihood that you will not forget to ask what is important to you. If you find you are short on time and the provider is dismissing you, start with the most important questions you want answered first.
- Bring someone with you to appointments; I mean bring them into the exam room. Most providers will allow one visitor in the exam room if you politely ask permission. A trusted friend, family member or an independent patient advocate to accompany you to an appointment is often beneficial for several reasons; plus it is harder to dismiss two people rather than one. You then have two sets of ears hearing the information which adds clarity and accuracy on what is shared as well as provides moral support.
- Don't hesitate to ask for additional explanation if you are unclear. You deserve to fully understand your treatment plan and options to allow you to make an informed decision about your care.
- Seek a second opinion if you feel your concerns are not being addressed. Not only are you a patient, but you are also a consumer of healthcare. You have the right to find a practitioner who will listen to you and acknowledge your concerns.
- Take the role of communicator. If you see gaslighting behavior from the provider or sense they are not listening, ask clearly yet politely, “Doctor, did you hear what I said?” or, ask the doctor respectfully, “What’s your plan, doctor?”. Once the provider acknowledges you, it's important to define the purpose of the visit and what you're hoping to get out of it. Whether it's a referral or a diagnostic test, try to move the conversation forward. At the very least, asking, “Who do you want me to see for this, doctor?” may help you find yourself following up with another doctor.
In Summary: to combat medical gaslighting, you must first recognize it. Secondly, advocate for yourself. If you do not feel you can do so adequately, seek the services of an Independent Patient Advocate. You are worth it!