Medical Gaslighting
After gaslighting became the world of the year, it is not surprising to hear of its use outside of the abusive relationship. What is medical gaslighting, and how does it affect physicians?
Since this is a blog for physicians, let’s focus on how physicians can suffer from gaslighting at work. First, let’s explain why patients believe that the medical-industrial system bends their reality.
What is Medical Gaslighting?
Medical gaslighting is a layman’s term used to describe physicians who deny a patient’s symptoms or illness. You might think of a patient who is told they are not sick or blame symptoms on psychosocial factors or conscious or unconscious biases. In essence, if you are subject to gaslighting, then someone has challenged your versions of reality and tried to show you how you are crazy (or the one with the problem) since you believe that way. It and projection are major defenses of narcissistic and other emotionally immature personalities.
Taking a physician-centric approach, a physician can be gaslighted or suspected of gaslighting.
Let’s start with why we might gaslight our patients.
Women and minority groups not infrequently get inferior medical care—is that medical gaslighting?
I want to be careful here because we know that discrimination and bias happen routinely in healthcare. This can be overt or hidden, conscious or unconscious. My thinking is that this type of abuse is not gaslighting. When using heuristics, physicians have a gestalt feeling about the diagnostic possibilities. That we have racists or other biases (that are often institutionalized) doesn’t mean that we are attacking others’ reality or accusing them of being crazy for thinking the way they think.
Discrimination is not gaslighting.
Women with chest pain wait for 11 minutes more on average to see an ED physician. This is gender bias and a lack of understanding that women often have “atypical” symptoms. Wait, isn’t calling a woman’s symptoms “atypical” gaslighting? What is typical, and who decides on that? This, again, is the heuristic diagnostic approach at fault rather than gaslighting all women. ED docs don’t deny the reality that women suffer from chest pain and have heart attacks.
Do doctors intentionally deny illnesses of those with non-binary genders, non-white skin, or financial challenges? If you ask them, of course, they don’t. They might admit that their colleagues do.
This is like cardiologists who order too many studies because it pads their pockets. Ask them what they are doing; they think they are doing the right thing every time and would do the same regardless of the money.
Ask someone to see something his salary depends on him not seeing, and what will he see?
From my perspective, more often than not, we are not dealing with gaslighting; medicine is structured to ignore certain people and certain medical complaints.
Horses rather than Zebras. Stigmatized conditions and diagnoses. And, of course, bias and discrimination.
My Experience of Medical Gaslighting
As an infectious disease physician, seeing post-infectious inflammatory syndrome was always challenging. Yes, I know you don’t feel well. Yes, an infection started the process. No, I can’t do anything about it. All I can do is tell you to eat well, exercise, and get enough sleep. And work on your intentions and mood. Maybe see a naturopath. It is real, and I see you. I recognize it. But still, what can I do besides hold your hand?
I can’t tell you how many bad patient reviews I got because I didn’t help. Because I couldn’t help. Honestly, I did my best to be of value to these folks, and almost uniformly, I got a bad patient review. Is that gaslighting when I did my best to validate these difficult patients but had nothing else to offer? Should I rather slam in a PICC line and give months of Ceftriaxone?
Each specialty has a type of patient encounter in which patients almost uniformly complain of gaslighting at the end of the visit. You know what I’m talking about.
Signs and Words of Possible Gaslighting
From a patient perspective, gaslighting is more likely if you are frequently interrupted, the answers don’t address your concerns, you feel ashamed or embarrassed after the visit, you leave wondering if it is all in your mind, and you are blamed for the symptoms.
Well, rushed visits, interrupting after 11 seconds, focusing on just one complaint rather than the whole, thinking about common conditions first… it sounds like healthcare is created to gaslight patients.
Here is a list of phrases or “warning bells” of gaslighting:
“It’s just your depression.”
“It’s all in your head.”
“Your pain is manageable.”
“You’re just tense.”
“You’re too young to have”
“You’ve got to expect this as you age.”
“All you need to do is lose some weight.”
“You’re overreacting.”
“Why are you getting so emotional about this?”
“It’s not as big of a deal as you are making it.”
“We never talked about that before.”
“You’re not that sick.”
“I know what’s best for you, better than you do.”
“Don’t you trust me?”
Don’t get me wrong; I’m sure some patients are kept from reading their medical records, are blamed for their conditions, are discouraged from doing further research or getting a second opinion, and are led to feel crazy. There are plenty of narcissistic physicians out there. I’m sure patients suffer from gaslighting every day.
My only suggestion is to be careful what is called gaslighting. Gaslighting involves denying your reality and suggesting that you are crazy to feel that way. Both are necessary. While discrimination is real and needs to be addressed, it is not gaslighting.
Physicians Suffering from Medical Gaslighting
As a physician, you are subject to medical gaslighting from your employer (or healthcare system).
Assuming that about 50% of department chairs are narcissists (and it is much higher in the C-Suite), you will routinely be emotionally abused by your boss.
I remember when they cut our 401k match, denied it several months later, and blamed us for poor performance (which was not true). Classic gaslighting from the overt narcissist CFO and covert narcissist CEO (once, they hired an incompetent CMO to piss each other off—it was a sight to see).
Expect to be emotionally abused as a physician (isn’t that the definition of residency?). Most commonly, your requests will just be ignored, and later, you will be accused of never making the request.
Other times, we see specialists using their status to convince us to do something against our instincts in patient care—to doubt our professional judgment, to keep the power gradients, the pecking order, to fall in line, to do things how they have always been done (because it is convenient for me). Gaslighting is entrenched in the power structures throughout the hospital and clinic.
They say it is all in your head. It is all in your head! Where else would it be?