Amber Belt, ND
If you’re a patient, have you ever had the experience of your practitioner blowing off or minimizing your symptoms? Or, worse yet, has your practitioner made you feel like you’re crazy and couldn’t be possibly experiencing your own symptoms? As a practitioner who has treated chronic illness and pain for well over a decade, this does happen. It’s called medical gaslighting and I want to shine a light on it so that we can all recognize it.
What is medical gaslighting?
Gaslighting in general is when someone, generally a person in power, makes another person (their victim) question their memory, their perception of reality, or their sanity. The person being gaslit will feel anxious and confused. While gaslighting is part of the dynamics of an abusive relationship, it can happen in the context of the patient-practitioner dynamic in medicine.
Medical gaslighting is when a patient’s symptoms are blown off, dismissed, or denied, which invalidates the patient. The practitioner may tell the patient that the symptoms they are experiencing are in their head, that the symptoms aren’t that bad, that their symptoms couldn’t possibly be due to condition X. Medical gaslighting generally stops the process to get the correct diagnosis and treatment for the patient which, of course, further invalidates them. Medically gaslit patients get scared and confused, can be misdiagnosed, or can have a delayed diagnosis.
I think it’s important for both patients and practitioners to recognize gaslighting. It’s also important for practitioners to learn how to avoid gaslighting in the first place.
Where does medical gaslighting happen most often?
Gender, race, and sexual orientation. I almost always see medical gaslighting in women. It’s subtle, but women are much more commonly seen as hysterical and emotional beings who don’t have the ability to discuss their symptoms without dramatizing them. People of color and people in the LGBTQIA community also see higher rates of medical gaslighting.
Pain. I see a lot of chronic pain in my practice. Folks with chronic pain whose source can’t be pinpointed are commonly subjected to medical gaslighting. I do a lot of regenerative injections like prolotherapy and PRP to address pain and many chronic pain patients’ pain isn’t actually coming from an impinged nerve or an arthritic joint. It’s common that their pain is coming from damage to a ligament or tendon. But imaging often isn’t sensitive to pick up on this microdamage, so these patients can be blown off when they ‘fail’ the conventional treatment or imaging doesn’t show where their pain is coming from.
Since pain is subjective, it can be easy to slide into a situation where a practitioner is medically gaslighting their patient. Pain patients are in, well, pain and this can seem overdramatic to a busy practitioner. And treating pain with drugs can be particularly tricky for the practitioner because there are patients who are drug seeking and overstate their pain to get more pain meds.
Chronic Illness. Chronically ill patients can be particularly challenging. Oftentimes, they will present to the practitioner with a collection of symptoms that seem unrelated and there are so many of them that it becomes overwhelming! With these patients, the practitioner gets overwhelmed by the sheer volume of symptoms and blows the patient off because it’s difficult to believe that a patient could possibly have that many symptoms and diagnosis is difficult when a large collection of symptoms is present.
However, a patient with conditions like POTS, long haul Epstein Barr virus, endometriosis, vaccine injury, dysautonomia, mold toxicity, fibromyalgia, or other non-standard condition can have odd symptoms that don’t seem to make any sense. In my experience, this type of medical gaslighting that these chronically ill patients are subject to is really just a lack of knowledge about these conditions on the practitioner’s part. When the practitioner is unfamiliar with a condition, the collection of symptoms can be complex and intimidating.
Sometimes, practitioners don’t ‘believe in’ a medical condition like dysautonomia or chronic Lyme disease and will medically gaslight their patient. But these conditions are there and they impact the patient in a life changing way.
With more COVID long haulers being seen, I’m hoping that more practitioners will think outside of the box and recognize that these complex patients have underlying conditions that are present. I have been treating long haulers of different varieties for well over a decade and they are frequently medically gaslit. Even if the tools to treat are limited, these patients still need to be validated. We can validate our patients by listening, getting labs done, and ordering imaging…even if the labs are ones we need to do a little research to interpret!
How does the current medical system set practitioners up to fail and be more prone to medical gaslighting?
First, I want to say that I feel very fortunate to have a cash pay practice. I’m not usually stifled by the parameters that insurance sets for conventional practitioners. However, I do get a little taste of the frustration when insurance companies try to tell me what medication is best for my patient. I mean, did the person behind the insurance desk just take an hour-long history followed by a thorough physical exam? Nope, so how could they POSSIBLY know what is best for my patient??
I think that having to center a practice around insurance codes to justify labs, imaging, and treatments benefits neither patient nor practitioner and it facilitates medical gaslighting. Of course, I do use these codes to justify labs and imaging but my office also has good relationships with labs and imaging centers to get patients reasonable cash pay prices when insurance refuses to pay for quality patient care. If a patient’s condition can’t fit neatly into an insurance-approved diagnosis, it’s easy to see how tempting it can be for the practitioner to blow off that patient’s symptoms.
I also think that the short amount of time that most conventional practitioners get to spend with patients promotes medical gaslighting. Got a complicated patient? No time for that! Their symptoms can’t be as bad and/or there can’t be as many symptoms as they are talking about. Sometimes practitioners just shut down and move on, dismissing patient symptoms or just pretending that certain symptoms don’t exist.
How do practitioners not gaslight?
First, both practitioners and patients must recognize that their relationship is a partnership rather than a parent-child type of relationship. The practitioner and the patient are both responsible for clear communication and each is accountable for doing their best in the patient-provider relationship.
With EMR and telemedicine, one of the biggest patient complaints I hear from patients is that their doctor never looks up from their computer screen during the visit. Obviously, that patient isn’t feeling heard and feels dismissed. I think, for the practitioner, brushing up on typing skills and developing the ability to type without looking at the screen would be very beneficial and help patients feel heard.
It’s also important that practitioners not dismiss a patient’s problems as a consequence of ‘getting older’ or from ‘hormones’. Of course, we know that age and hormone balance play a big role in health but women often blown off when the doctor says, ‘well it’s just hormones.’ That’s medical gaslighting and it’s not good care for the patient. I’ve had a female patient be told that they were ‘getting older’ when they talked to their practitioner about knee pain while running. She was also told to stop running! It turns out that this patient had a medial meniscus tear combined with MCL damage that we repaired with prolotherapy. For the record, she’s running again. I’ve also had women who are told that their bad periods are ‘just hormones’ when, really, it’s endometriosis or PCOS. As practitioners, it’s our responsibility do better and investigate the root cause of our patients’ problems.
As a practitioner, it’s important to recognize that it’s ok to suggest to a patient that they get a second opinion if you aren’t able to figure out what’s going on or if your treatments aren’t effective. Patients appreciate that their practitioner is advocating for them in this way. Being honest with your patient when you’ve reached your limit ensures that they feel heard, even if that means they get care from someone else.
It’s ok, too, to tell a patient when you can’t figure them out. I often tell patients that there are details of their case I need to research because my knowledge is a bit rusty or they have some unusual aspects to what’s going on with them. They might feel like they are a patient with a challenging condition (which they may be) but they don’t feel blown off or crazy.
For both patients and practitioners, if there’s a disagreement between the two of you, don’t take it personally. I often see practitioners get defensive when a patient disagrees and/or asks questions about aspects of their care. Try to reframe that disagreement as an opportunity to ask more questions and clarify what your patient is feeling. It’s also a good opportunity to teach patients more about what you think is going on with them. Patients who ask a lot of questions are generally quite willing to take in information and learn.
How a patient’s treatment is framed up matters. Many times, my chronically ill patients tell me that an anti-anxiety or anti-depressant was prescribed for them without explanation. This form of medical gaslighting makes the patient think that you think they are crazy and that their symptoms are all in their head. If you are prescribing these meds, it’s good for the practitioner to take a little extra time to explain to the patient why you are prescribing and how this fits into the long-term treatment plan. The patient needs to know their practitioner is on their side.
Practitioners, call yourself out if you need to. If you’re feeling overwhelmed or overworked, you’re more likely to medically gaslight your patient. We all are. If you’re getting into the headspace where your patients are annoying you, it’s probably time to check yourself and get back into the right headspace where you can offer quality and compassionate care.
While we don’t want to tell patients that their ailment is ‘all in their head’ it is important to recognize the mind-body connection. This doesn’t mean throwing Prozac at chronically ill patients, but it does mean that you can gently explore treatments like meditation, clinical hypnotherapy, prayer, therapy, or other non-medication based treatments to help your patients’ minds and bodies.
Once in a while, we do find those patients whose symptoms and conditions are so deeply a part of who they are that it almost feels like they don’t want to get better. After all, who would they be without their illness? These patients are really easy to blow off and medically gaslight. In this case, referral to a psychologist is good while you are working on the physical treatments, but you also need to meet them where they are at. Maybe try asking them what specific symptoms they want to address during that visit. Or maybe this is the patient who needs a second opinion or a provider who is outside of the conventional system. Of course, their connection with their diagnosis doesn’t mean they are less deserving of care but it may mean that they may need more diverse treatment options to help them get well.
What can patients do to prevent medical gaslighting?
Patient advocacy resources suggest that bringing a person to a patient’s visit can cut down on gaslighting because it often happens when the patient and practitioner are alone. That suggests that accountability from another source cuts down on medical gaslighting, so having another person at your visit can be helpful. There are also services that record patient visits, which may provide a similar accountability to having a person in the room with you.
While this article is practitioner focused, I think patients can benefit from reading it as well. If we bring medical gaslighting into the open and can identify it, we can recognize it for what it is if it does happen. Recognizing medical gaslighting for what it is can help take away its power, both on the practitioner and the patient sides of the relationship.