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March 30, 2022

Medical 'gaslighting': What it is—and how to address it

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Sep. 13, 2022.

    Research suggests that diagnostic errors occur in up to one-in-seven interactions between doctors and patients—and female patients and people of color are even more likely to have their symptoms dismissed by medical providers, often resulting in a delayed or incorrect diagnosis.

    Cheat sheet: Health disparities at the point of care

    What is 'medical gaslighting'?

    The term "medical gaslighting" is used to describe patients who have felt that their symptoms were arbitrarily dismissed as insignificant or labeled as primarily psychological by doctors. According to the New York Times, the term came from a play entitled "Gaslight," in which a husband tries to drive his wife insane.

    For many patients, the search for an accurate diagnosis and treatment has the potential to be just as maddening.

    Who is most affected by medical gaslighting?

    According to the Times, many women have experienced medical gaslighting when their doctors blamed their symptoms on their mental health, weight, or a lack of self care—which often results in delayed diagnosis and treatment.

    For instance, Karen Lutfey Spencer, a researcher who studies medical decision making at the University of Colorado, Denver, found that women were twice as likely as men to be diagnosed with a mental illness while experiencing common symptoms of heart disease.

    More broadly, research suggests that women are more likely to be misdiagnosed than men in many situations. Additionally, women wait longer to receive a diagnosis for a variety of conditions, including cancer and heart disease, they are treated less aggressively for traumatic brain injuries, and they are less likely to be given pain medications.

    Research has also shown that people of color often receive lower quality care and that doctors are more likely to describe Black patients as uncooperative or non-compliant. This can have a negative impact on the quality of treatment received.

    "We know that women, and especially women of color, are often diagnosed and treated differently by doctors than men are, even when they have the same health conditions," Spencer said.

    A recent survey, commissioned by athenahealth, found that 64% of female respondents reported increased stress and anxiety levels during the Covid-19 pandemic, and 52% said their anxiety resulted in a physical health concern, such as bad eating and exercise habits. However, according to the survey, 54% of women and 67% of millennials said they had health concerns they didn't tell their doctor about because they didn't want to appear anxious, dramatic, or silly.

    "It's no accident that the word 'hysteria' originates from the Greek word for 'uterus,'" said gynecologist Stephanie Trentacoste McNally. "There's still this pervasive belief in the medical community that any time a woman complains about her health, it's either related to her hormones or all in her head."

    According to Chloe Bird, a senior sociologist who studies women's health at Pardee RAND Graduate School, women may be misdiagnosed more than men because scientists know significantly less about the female body despite "biological differences that go down to the cellular level."

    In 1977, FDA started recommending that scientists exclude women of childbearing age from early clinical drug trials, fearing potential harm to a fetus if a participant became pregnant. In addition, researchers were concerned that hormonal fluctuations could interfere with study results.

    However, a law passed in 1993 required that women and minorities be included in all medical research funded by the NIH. Although women are included in more studies today, there are still significant knowledge gaps.

    How to improve care

    Many experts agree that it is difficult to determine the best way to address these systemic problems, the Times reports. However, some scientists have argued that there at least needs to be more research centered around women's health conditions.

    According to Spencer, doctors should be allowed to spend more time with their patients and see fewer patients overall.

    Typically, physicians work under difficult conditions that can "make it easy to make mistakes and oversights," Spencer said. "It's like a gauntlet of problematic systems and processes that invite bias."

    Researchers have called for increased training in medical school about unconscious bias and racism in the health care industry. In 2019, California passed a law that requires hospitals to implement bias programs for any health care providers with a focus on perinatal care.

    However, until "medical gaslighting" becomes less prevalent, women and patients of color might want to consider bringing a trusted friend or relative to their appointments, said Alyson McGregor, co-founder and director for the Sex and Gender in Emergency Medicine division at Brown University. "It really helps if you have an advocate there [who] can intervene and say things like, 'She is not normally in this much pain,'" she said.

    In addition, McGregor suggested patients "see another doctor if [they] feel dismissed." Patients might also want to consider finding a provider with better cultural competence, who may better "understand [their] perspective and language." (Leech, Bizwomen, 3/28; Moyer, New York Times, 3/28)

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