Gaslighting is a term that has recently come into popularity to describe interactions between people in many different settings including healthcare. To gaslight a person is to interact in a way that leads an individual to question themselves and their own ability to perceive or interpret the reality of a situation.
Some common phrases/situations that might suggest you are experiencing medical gaslighting are:
"It's all in your head."
"You are overreacting."
"That isn't important."
"You are being too sensitive/emotional."
"It's because of your period."
"We never talked about that."
"That never happened."
"I'm the doctor, don't you trust me?"
"I think you're confused."
"That's not possible."
"If you just did what I told you, you should be fine."
As a word of caution, those phrases do not necessarily mean you are being gaslit. For example, a physician might tell you that the arthritis the x-ray in your neck shows isn't a big deal, and that may be an honest opinion. Studies have shown that 85-90% of people over the age of 60 have arthritis in their neck, and the vast majority of them don't have constant neck pain. (1, 2) The x-ray your physician received may in fact include a report from the radiologist stating that you have mild arthritis in your neck that is consistent with normal age-related changes. That physician should however, then acknowledge that you are having neck pain, and offer you other testing or alternative treatment options as solutions.
We have to be careful to not apply the term of gaslighting to every doctor whose opinion we disagree with. If they have data to support their opinions, they are entitled to have a professional opinion that is different than yours, and may even be different from the opinion of another doctor.
If you do feel that you are being gaslit by a doctor, just changing providers may or may not help you. The next doctor may behave the same way, and there are some inherent dangers to always changing providers to find someone who agrees with you.
In hopes of helping patients, and encouraging providers that gaslight to learn from their mistakes, here are some do's and don'ts, as well as some approaches to manage it that are grey areas where you should proceed with caution.
Things that do not help:
Displaying emotional frustration. While you may be entitled to it, if a doctor already thinks you are over-reacting, this will only reaffirm their belief.
Yelling or speaking to the provider (or the office staff) disrespectfully. This isn't a sign of a mature person, making a reasonable request. It communicates desperation and disrespect. You are better off improving your argument than raising your voice. As a side note, this applies to office staff too. If you are rude to them, they are less likely to help you. Most office staff tell the physician how they are treated by you.
Asking to see another doctor in the practice/health system. These doctors share notes, and they work together. They are unlikely to disagree with each other significantly. While some doctors do make an effort to work on well rounded teams with other people who think differently than they do, this is rare, and not usually the provider that would gaslight someone in the first place. Most people tend to prefer being around other people who look and think like them. Furthermore, some practices have rules about not getting second opinions within the same practice to prevent doctors from being pitted against one another in the event of a lawsuit.
Finding another provider, and never communicating again. If a doctor misdiagnoses you, and you get another opinion that proves helpful, let that provider know. This provides an opportunity for them to grow and learn what they missed in your case. You may help the next person who sees that provider to avoid the negative situation you faced.
Leaving bad Google reviews. If you post things on the internet that you did not give the doctor the chance to make amends for first by communicating about it with them and their office directly, they will write you off as having poor communication skills, and being out of touch. If the review is in conflict with your medical record, they could even come after you for defamation. If you are going to leave a bad review, be very thoughtful about what you say. Stick to the facts that you can back up with evidence, and be careful when talking about emotional things to use "I felt" statements about how you felt in response rather than accusatory ones to say "They made me feel ______".
Talking about friends with similar conditions. While it's normal to try and come up with answers based on your life experiences and relationships, it doesn't mean much to your doctor. Whether or not you are right, there is a lot of bad information out there, and doctors generally ignore your personal experiences with friends, in favor of data/research, or their clinical experience. (*This does not apply if discussing a family member to whom you are genetically related.)
Asking for a medication. While it is normal to want relief from your symptoms, asking for pills inadvertently can get you labeled as "drug seeking", which doesn't help your case. Ask instead if there is anything that can be done to manage your symptoms, or better yet, treat the cause. Let the doctor be the one to suggest medications.
Sharing information that would suggest ulterior motives. (i.e. seeking disability, looking to be given time off work, etc.) These are yellow flags for doctors. While most people are not just looking for a free lunch, a few people are, and that ruins it for everyone. Try and communicate what your limitations are, rather than outright asking for accommodations. Try to let the doctor be the one to suggest it. If you have to bring it up, it's better to ask for it on a short term basis. This communicates that you are hopeful to go back to your responsibilities and hope the doctor will be able to help you manage your symptoms so that you can do so.
Things that may or may not help:
Talking about things you read online. Facebook support groups, and internet forums of patients aren't seen as reputable sources of information by providers. That being said, if you bring in a research article from free online databases like PubMed about a condition and highlight the portions you think apply, it is viewed differently. It may be better received by your doctor. Consider either bringing 2 copies, or submitting it to your provider electronically so that it can be added into your chart. That gives you proof that it was discussed with them.
Confronting the provider on the financial benefit they gain from referring to in-house specialists rather than the person best for your care. Most hospitals pressure their doctors to refer to their own specialists instead of outside providers. You might succeed in making the provider feel bad about it if you confront them on the fact that while this is legal, it's unethical, but it ultimately is unlikely to make them treat you differently. They are more likely to become defensive, or label you as a conspiracy theorist for thinking that the hospital system is out to prevent you from getting the best care. Even for doctors who are bothered by this, many feel helpless to change their situation and have just accepted it as something they can't control.
Insisting on seeing the higher education level provider (i.e. the physician instead of the physician's assistant or nurse practitioner). This is sometimes appropriate if your case truly is that complicated, but proceed with caution here. If the doctor highly values their assisting staff, they can see this request as disrespectful to the quality of the other staff members, and feel like you are unnecessarily taking up their time. Most doctors would prefer that they are the person who decides which patients need to see them for clinical reasons. In fairness, as a patient, you don't (and aren't allowed) to know the situations of the other patients who also need their time. Demanding to see the highest educated provider can inadvertently communicate a lack of trust in the provider to decide what level of care you need and be seen as disrespectful. You may also want to consider that you are more likely to get a longer, or a sooner appointment with the assisting staff, and they are sometimes more people-oriented. Individuals who choose to go to school to be a healthcare provider that works under another provider are more likely to be humble, and less likely to insist on believing that their way is the high way. This can be an advantage if you and your doctor aren't in agreement about your case.
Requesting a copy of your medical records. This can make some doctors nervous that you are going to sue them, but it may also let them know that you are paying attention to their behaviors which might prompt change. Doctors are sometimes overwhelmed with their workload and their documentation; this may make them pay closer attention to yours.
Asking permission to voice record your visit. Most doctors will say no, or deflect and tell you that they have to consult a supervisor on if this is even allowed. Different states may have different laws on who can be recorded and when.
Ask the provider to reflect back to you what you have told them. This is time consuming for them, and may feel inefficient to the provider who is on a tight schedule. It does, however, ensure that you know if they are understanding what you said, and if they are listening. It also gives you a chance to correct misunderstandings. Providers are encouraged to use reflective listening with patients when they are in school, but in a real clinic situation, time limitations can make this difficult.
Things that do help:
Being kind, and calm.
Writing out your case clearly. Bring a paper copy to your appointment for your reference to stay on track. Leave a copy with the office staff and request it be added to your chart as a record of what you discussed.
Reasoning with the provider regarding their dismissal of your symptoms
Acknowledging that you do not expect the provider to have all the answers. Doctors and medicine are not all-knowing and have not discovered everything about how the human body works. Sometimes gaslighting occurs out of a provider having a hard time admitting that they don't know the answer.
Putting a complaint in writing to the individual first, not the office. If they are unresponsive to your concerns, escalating the complaint to the office/hospital is appropriate.
Offer to pay for an extended appointment time in cash. The office likely won't (and can't) accept the offer, but it communicates that you are serious and your health is valuable to you. If the office accepts insurance, they can't charge you more than your insurance negotiated fee.
Talking about a family member who received a diagnosis for similar symptoms. If you have a biological relative with the same condition, the genetic relation can increase the likelihood of you having the same disorder (if it is a genetically linked condition), and will make it more likely your doctor will order testing for you.
Bring someone with you to your appointment. It can be good for a provider to know that they are being watched, and someone else will testify to what they say. It is helpful if the person you bring spends a lot of time with you and can back up your story/symptoms.
Finding a provider who will listen to you, and advocate for you with other providers. Some doctors value and are more open to the opinion of other providers than the opinion of a patient.
It may help to take a step back and understand the situation from both a provider's point of view, and a patient's point of view. Understanding both sides of the situation can help improve communication.
The Providers:
Generally care about their patients.
Usually believe that they are the expert, and likely know more than the patient on the subject. They spend a long time in school, and dedicate their lives to seeing patients everyday which gives them experience their patients lack.
Are usually under constant pressure to have all the answers.
Were typically high achieving students, and are used to being right about most things.
Due to spending significant time in school and on their career, they can begin to hold their career as part of their identity. Failing to have an answer for a patient can become a reflection of personal failure not just a professional failure.
Are expected to explain complex medical concepts quickly, in a way that patients understand.
Are surrounded by patients with medical conditions which may be more or less severe than the patient they are seeing. This can desensitize them to what they perceive as comparatively more minor conditions.
Are usually under financial pressure to produce answers quickly and move on to the next patient.
Are usually under significant business and financial pressures to only refer within certain networks of specialists (i.e. within their own hospital system).
Are usually afraid of and trying to avoid litigation at all costs.
The Patients:
Are generally honest in seeking care/services.
Are coming to a doctor seeking advice and answers, but first want to be listened to.
May or may not have experienced or known others with more severe medical conditions than what they are experiencing. Therefore, their condition can seem like a really big deal to them.
May be in pain, sleep deprived, or otherwise physically impaired/uncomfortable
May have anxiety associated with not knowing the severity of the condition and what is happening to their body, or about the condition being incurable.
May be depressed due to inability to do their usual daily activities.
May be under financial pressure to get answers and treatment. This is true of anyone paying doctors bills, but especially if the condition limits the patient from working.
May feel socially isolated by their condition either limiting their ability to be with friends and family, or because their social support system doesn't believe in their symptoms.
The intent of this article is to improve understanding and communication between patients and providers. It is not intended to replace individual medical advice from a licensed provider. If you are seeking personalized medical advice, please contact our office to schedule an appointment with a licensed medical provider.