What is Medical Gaslighting

Medical gaslighting can be a big problem for those suffering from chronic illness and others seeking medical care. It can prevent patients from getting the treatment they desperately need and can reduce their trust in healthcare providers. At its worst, it can be traumatizing, disabling, or even fatal.

What is Medical Gaslighting

Medical gaslighting is when you have a healthcare provider dismiss or downplay your symptoms or attributes them to something else, like a mental health condition. It is when the healthcare provider does not preform necessary evaluations without valid grounds and prematurely dismisses your genuine clinical concerns. Some examples of medical gaslighting include:

• Failing to order tests or referrals for prolonged pain that interferes with the client’s life.
• Not ordering tests to rule out heart issues for chest pain and instead deciding that it was anxiety.
• Not investigating a certain condition that a client matches up with because they are “too young” to get that condition.
• A doctor that attributes pain or low energy to weight or age without any tests.
• Telling a patient that it is psychosomatic without ruling out structural causes.

Medical gaslighting can be linked to missed diagnoses, delayed treatment, or poor health outcomes. It can damage your trust in the healthcare system and make you less likely to seek care. It can leave you scared, doubting yourself, isolated, and uncomfortable.

Red Flags of Medical Gaslighting

Medical gaslighting can be hard to catch while it’s happening. It can be subtle, you may be stressed or feeling really bad. Some behaviours by healthcare providers that may indicate medical gaslighting:

• Blames your symptoms on your age, gender, weight, lifestyle habits, stress, menstrual cycle, or sexual orientation
• Rushes you through an appointment.
• Downplaying or dismissing the patient’s symptoms and fail to take their concerns seriously
• Doesn’t listen to the patient or constantly interrupt them
• Lack of empathy or sensitivity to a patient’s pain or concerns
• Blame the patient for their condition
• Attribute the cause of a medical issue to a mental health condition, like anxiety, depression or trauma
• Refusing to discuss your symptoms with you
• Tries to convince you it’s all in your head/psychosomatic (psychological gaslighting)
• Pushing past your concerns and proceeding with treatment
• Insisting you have no other treatment options besides the one they are suggesting

What Can Cause Medical Gaslighting?

There are a number of reasons behind medical gaslighting. It is not always intentional.

Defense Mechanisms

Sometimes, it can be a defense mechanism for the healthcare provider’s lack of communication skills, time to speak with the patient, or knowledge about the patient’s concerns. Likewise, gaslighting can occur because the healthcare provider does not know the next steps to take for the patient’s concerns. For example, there may not be a straightforward test for diagnosis or the doctor can’t make sense of the patient’s symptoms. In these cases, gaslighting has more to do with the healthcare provider’s uncertainty or insecurity.

Biases

Unfortunately, medical gaslighting can also come from conscious or unconscious bias, of which there is a significant amount in medicine. Women, people of colour, and other marginalized groups are more likely to have their concerns or questions not taken seriously. Certain conditions, like long COVID and chronic Lyme Disease, often present with nonspecific physical symptoms and are not well understood by physicians and can lead to dismissed complaints and misdiagnoses.

Healthcare provider biases and stereotypes can lead them to treat different patients differently. For instance, chronic pain in older adults may be dismissed as a “natural part of aging,” while females were more likely than males to have their symptoms downplayed due to a stereotypical perception that they are more emotional and dramatic about their experiences. Likewise, Black (African American) patients were more likely to have their symptoms attributed to “malingering” as compared with their White counterparts. These types of biases can lead to medical gaslighting and patients receiving improper or inadequate care.

Arrogance

While patient autonomy and shared decision-making have become important concepts in healthcare delivery, unfortunately, there are still physicians who hold onto the schema that the “doctor knows best” when it comes to clinical decision-making and treatment. In such cases, the arrogance of physician superiority may lead to clinical symptoms being ignored and patient concerns remaining unaddressed. There is also so much health information and research out there that it is impossible for a doctor to keep on top of everything.

Systemic Constructs

Healthcare providers often make decisions with aid of clinical heuristics or diagnostic algorithms, which carry the risk of cognitive bias. Over-reliance on such simplistic rules of thumb may contribute to bias and premature diagnostic closure. Additionally, many established clinical algorithms have also been found to contain racial and sex biases contributed by the training data or model developer. These systemic biases can become entrenched, so that gaslighting becomes a learned, subconscious, and intuitive behaviour by both physicians and trainees.

Who Tends to Experience Medical Gaslighting More Often?

Women, people of colour, people who are overweight, people with chronic illnesses, and members of the LGBT community experience medical gaslighting more than others.

Women

Women are more likely to experience medical gaslighting than men. They are twice as likely to have their symptoms attributed to a mental health condition or be told that their pain is “in their head.” Additionally, women with heart disease are often treated less aggressively than men and aren’t as well represented in clinical trials. They are often diagnosed later than men (some studies say on average 4 years), receive inadequate pain management or longer waits for pain medication, and wait longer for treatment than men.

People with Chronic Pain and other Chronic Ailments

People with chronic pain, long COVID, and medically unexplained symptoms often experience medical gaslighting by health professionals. They may have to wait 8 years for a proper diagnosis and have to go through multiple providers before they get answers. Sometimes, medical providers may wrongly point to psychosomatic issues as a root cause, which is another form of medical gaslighting.

People with “Weight Issues”

People with “weight issues” can experience a lot of medical gaslighting. When considering if someone is “overweight,” they often use BMI, which was created using European male measurements in 1832! This means genetic variations may not be considered and they may be pushing patients to get to a certain weight that is not healthy or achievable for that person’s genetic disposition. Some doctors may even deny approving procedures based on this measurement. Others may experience their weight being brought up no matter what they are coming to the doctor for.

BIPOC

People of colour often receive a lower quality of healthcare than white people. They are more likely to have their stroke symptoms misdiagnosed. Providers are more likely to use negative descriptors, such as “non-compliant” or “agitated,” than white patients. Plus, they often don’t receive adequate pain medication.

LGBTQIA+ Community

Members of the LGBTQIA+ community experience discrimination in numerous societal settings, and healthcare facilities are no exception. One report found that over 50% of gay, lesbian, and bisexual patients and 70% of transgender respondents experienced discrimination while seeking medical care. They may experience healthcare providers asking inappropriate questions unrelated to reported symptoms, denying or dismissing experiences, not using preferred names or pronouns, and even refusing to treat them.

Senior Citizens

Some of the ways senior citizens experience medical gaslighting include dismissal of symptoms because of age or assumptions, like the belief that older patients are less compliant with treatment, that lead to invalidation, dismissal and gaslighting. Misdiagnosis is also a problem with this population, and it can cause inappropriate tests or treatment, psychological upset, and financial stress.

What is Not Medical Gaslighting?

• A doctor refusing to order excessive medical tests or refusing to order a test that they don’t have a rationale for.
• A lack of medical treatment options for your condition: Unfortunately, for some conditions, there are not many options for medical treatment, and you may have exhausted them.  This is when you may need help from alternative and complementary forms of healthcare to help you manage your condition.
• Strained resources: Healthcare providers may be limited by how much testing they can order and other procedures in ordering testing. Often, more advanced tests have requirements before they can be ordered.
• Your doctor is limited in the answers they can give you: Family doctors often don’t have the knowledge to treat more complex conditions, and that is why they refer you to a specialist or a specialty clinic. A specialist may not have the knowledge if they are the wrong specialist for your concerns.
• Your healthcare professional was not given enough time for your appointment: Doctors are under much pressure to work faster and see more patients. They simply may not have enough time in your short visit to cover all your concerns. Please respect your doctor’s time and the clinic’s rules about what can be addressed in one appointment.
• More research is needed. There is more research needed for many chronic and rare conditions. Sometimes, your doctor and the medical field just don’t have the answers and are trying the best they can with limited information and time to provide care for you.
• Disagreements with your doctor. Just because you have a disagreement with your doctor doesn’t mean they are gaslighting you.

How Can Medical Gaslighting Be Damaging?

Medical gaslighting can be physically and emotionally damaging in various ways. Patients can spend much time and energy trying to find a doctor who can accurately diagnose and properly treat their symptoms. They spend much time in doctor’s visits, excessive tests and appointments, just trying to get answers and adequate treatment. As they are searching for answers, the gaslighting from previous doctors may make them less credible to the new doctors they are approaching.

Medical gaslighting can be incredibly distressing for patients because the people who are supposed to be helping them are not helping. They may develop anxiety, depression, or PTSD from their experiences. The emotional distress of medical gaslighting can take a toll on a patient. As feelings of powerlessness and helplessness intensify, they may consider suicide as a way to get out of their pain.

Medical gaslighting often leads to worse medical outcomes. As the condition they have is not properly treated, it may get worse and they may have worse health outcomes. For example, research on traumatic brain injury (TBI) has shown that women are less likely than men to be admitted to intensive care following a mild TBI, and women with a moderate to severe TBI were hospitalized for a shorter duration than men. Seemingly, as a result of these issues, women with a TBI had worse health outcomes after six months than men.

How Can Medical Gaslighting Be Dangerous?

There have been cases where medical gaslighting has been fatal. The symptoms of a stroke have been dismissed because of healthcare provider bias and the patient dies, because their symptoms weren’t taken seriously.

People who have experienced medical gaslighting may be less inclined to seek help when they feel unwell. This may mean that they don’t get the medical help they need.

How Can Medical Gaslighting Be Traumatizing

Medical gaslighting can make you feel helpless and powerless because of the power differential in the doctor-patient relationship and how much is riding on your health. Unlike some other relationships, there are certain things you can only get with a doctor’s referral.

What Can You Do to Avoid Medical Gaslighting?

Some of the things you can do to prevent medical gaslighting include:

• a journal tracking the symptoms you’ve been having
• a brief and precise expression of your medical concerns
• take a summary page of your symptoms that can be scanned into your file
• a short list of questions for the clinician
• a buddy who can support you, take notes, and observe your interaction with the clinician.

Let the clinician know that you have questions that you would like to ask at the end of the appointment.

What Can You Do If You Have Experienced Medical Gaslighting?

Clinicians usually don’t feel they have gaslit their patients, so how can you deal with medical gaslighting in the moment?

• Take a step back. There may be a misunderstanding. See if reframing your question or request gets a different answer.
• Ask pointed questions. You may ask for a test to rule out a condition or ask some follow-up questions about what the doctor thinks is going on or what the greater treatment plan it.
• Communicate how your symptoms are affecting you. Sometimes, you may assume that the doctor realizes how much you are struggling based on the symptoms you are communicating when the doctor hasn’t made that connection.
• Ask your buddy for support. Your support person may advocate and lend credibility to what you’re saying.
• Get a different clinician. You have every right to a second opinion or to change clinicians. You deserve better treatment.

Advocate for Better Care

If the medical gaslighting happened in a facility under a public health authority, you may be able to contact a Patient Care Quality Office or something similar. Some facilities also have a patient advocate that you can utilize.

If you have concerns about what is written in your medical record, you can request it ,and  if necessary, you can request corrections or amendments to it.

How Can You Heal from the Damage of Medical Gaslighting?

An important thing you can do to heal from the damage of medical gaslighting is to focus on what you are hearing from care providers that don’t gaslight you. If you don’t have any, see if you can find support groups or other places of understanding. You may want to reach out for a second opinion or look for a new doctor. Start to build a team around you that doesn’t gaslight you.

Remind yourself that it’s not you. Medical gaslighting is often more about the person doing the gaslighting than the victim. There may be external factors that have nothing to do with you.

Take care of yourself. You deserve to be treated better. Engage in self-soothing and self-compassion.

Trauma therapy. If the medical gaslighting is significant enough, addressing it with a trauma therapy like EMDR may be needed to help you put it in the past rather than having it interfere and be triggering in the present. It may also benefit to see a therapist experienced in gaslighting or psychological (emotional, narcissistic) abuse.

Conclusion

Medical gaslighting can be a big problem for those seeking medical care. It goes against the medical values of ‘do no harm.’ It can do a lot of harm to victims and their beliefs that healthcare providers are there to help them. However, there are ways to heal if you have been a recipient of medical gaslighting.