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August 2, 2022

5 ways to protect yourself from 'medical gaslighting'

Daily Briefing

    Having concerns dismissed or overlooked by a health care provider is a frustrating experience and can lead to misdiagnoses or unnecessary delays in care. To help patients, health experts offer tips on how to spot and combat "medical gaslighting."

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    What is 'medical gaslighting'?

    The term "medical gaslighting" describes when patients feel their symptoms were arbitrarily dismissed as insignificant or labeled as primarily psychological by doctors. For example, some patients are told, "It's all in your head," or "There's nothing medically wrong."

    According to the New York Times, medical gaslighting isn't always easy to spot, but health experts have identified certain red flags to watch for when seeking medical care, such as when a provider:

    • Is not an engaged listener, does not allow you to elaborate on your symptoms, and routinely interrupts
    • Diminishes or downplays your symptoms, including questions whether you have pain
    • Will not discuss your symptoms
    • Will not order any key lab or imaging work that could rule out or confirm a diagnosis
    • Acts rude, condescending, or belittling
    • Attributes your symptoms to mental illness, but does not provide you with a mental health referral or screens you for a mental illness

    "I always tell my patients that they are the expert of their body," said Nicole Mitchell, the director of diversity, equity, and inclusion for the obstetrics and gynecology department at the Keck School of Medicine of the University of Southern California. "We work together to figure out what's happening and what we can do about it. It really should be a shared decision making."

    How patients can advocate for themselves

    "When it comes to your physical and mental health, you have to be your own advocate," writes Deborah Serani, a psychologist and psychoanalyst, in Psychology Today. "You need to create a team of health-care experts who make you feel heard, seen and valued."

    To help patients advocate for themselves, health experts offer some recommendations, including:

    1. Keep detailed notes and records

    Mitchell recommends patients keep a journal to record as many details about their symptoms as possible. Some of her suggested prompts include, "What are your symptoms? When do you feel those symptoms? Do you notice any triggers? If you have pain, what does it feel like? Does it wax and wane, or is it constant? What days do you notice this pain?"

    In addition to keeping track of symptoms, patients should also keep records of their lab results, imaging, medications, and family medical history.

    2. Ask questions during a visit

    According to Mitchell, patients should prepare a list of questions to ask before their appointments and be ready to ask new questions as more information is presented.

    If patients aren't sure how to start, Mitchell recommends asking their doctor what questions they would ask if they were in the patient's position.

    3. Have someone support you during appointments

    When people are sick, scared, or anxious, it can lead to "brain freeze," said Jennifer Mieres, a professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. "We stop thinking, we don't hear adequately, we don't process information."

    Having a trusted friend or relative come along to an appointment can help patients feel more comfortable, especially if they're discussing a treatment plan or difficult medical issue. In addition, Mieres recommends clarifying the support person's role ahead of time. Do you want them to take notes or be there primarily for emotional support?

    4. Focus on the most concerning issue

    According to a 2021 study, the average primary care exam is only 18 minutes long, which means it's important for patients to convey information to their providers quickly and concisely. To make this easier, Mieres recommends taking 10 minutes before an appointment to write down a few bullet points about the primary reason for your visit.

    5. Figure out the next steps

    After the end of an appointment, patients should tell their providers that they want to understand three things:

    • The current best guess at what is happening with their symptoms
    • A plan for either diagnosing the condition or ruling out potential conditions
    • Potential treatment options, depending on what the condition ends up being

    What can patients do if they're still being ignored?

    If you are still being ignored after advocating for yourself, experts recommend switching to a different provider to get a second or even third opinion. According to several studies, around 88% of patients who seek out a second opinion will leave with either a diagnosis or a new direction to pursue with their symptoms.

    In addition, patients who are being treated at hospitals can reach out to patient advocacy staff for assistance or contact a doctor's supervisor to report a problem. And if you're unhappy with the care you've received, you may want to consider reporting your experience to the Federation of State Medical Boards.

    "Any instances of abuse, manipulation, gaslighting, delaying diagnoses — those are reportable events that providers need to know about," Mitchell said. "Doctors need to be held accountable." (Caron, New York Times, 7/29; Serani, Psychology Today, 7/27)

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