- More patients are speaking up about having their symptoms dismissed by doctors.
- Often, systemic issues and the way clinicians are trained can lead to perceived gaslighting.
- This is Dr. Mikhail Varshavski's perspective on why medical gaslighting happens and how patients can address it, as told to Anna Medaris.
This as-told-to essay is based on a conversation with Dr. Mikhail Varshavski. It has been edited for length and clarity.
People are fed up with the way the healthcare system functions.
The most common theme I hear is from patients who feel providers put a very heavy emphasis on being overweight while ignoring other symptoms.
Another thing patients point out is doctors not listening to their mental health concerns.
The final common complaint is from patients who may have chronic pain, and they feel they are not being treated fairly because doctors think they just want medications for controlled substances.
In all of these cases, I can see both sides of the equation, being a provider as well as a patient advocate.
As a physician, I know that a lot of things can go wrong when a patient carries excess weight, but it doesn't mean that if there are other symptoms present, we don't have to look further.
A lack of attention on mental health is usually a systemic issue, rather than a provider issue, because there's not enough training that goes into mental health for all specialties.
And when it comes to pain, we have to be quite careful and make sure that we're not harming our patients by prescribing them something, but at the same time not keeping away medications from someone who actually does need it.
What appears to be gaslighting may be something else
I don't think that there's suddenly more doctors out there gaslighting patients. I think that the system creates communication breakdowns that, to the patient, look like gaslighting situations.
What a doctor might be saying could be correct advice delivered in a non-patient-friendly way.
It could be that the doctor's under a crunch because of something that happened earlier, so it's outside of the doctor's control that they have limited time with the patient.
Doctors are trained to enter data on the computer as the patient is talking to them, but that can leave a patient feeling unheard. When you're sort of devolving a patient to a series of checkboxes, that feels devaluing. And that's not the provider's choice.
The most misunderstood point about the whole gaslighting conversation is that good providers can fall victim to this. This can happen to anyone.
There are sometimes doctors are truly gaslighting and don't really care for whatever reason.
Doctors should take a team-based approach to treatment and diagnoses
The best way for providers to not fall victim to perceived gaslighting that is within our control is to be as transparent as possible.
So sometimes, I do have to be in the computer and go through a checklist. So I'll vocalize to a patient and say, "Hey, for the first part of this visit, I really need to go through these check boxes. It's gonna sound robotic, but bear with me, we'll get through this. And then we can have a normal conversation."
Patients are very appreciative of that, but that's not something that's taught – that's something that has to be sort of discovered or understood by shadowing a physician who does that.
Another thing providers really should be doing is explaining their pathway and their reasoning as to why they're making a specific diagnosis, as well as why they think a certain treatment would work, because it needs to be a team-based approach.
I may have in my head the few diagnoses that I think are most probable, as well as the treatment plan for each one. But before explaining that to the patient, I ask, "Do you have any theories as to what's going on?" Or, "Do you have any worries specifically about a condition you think this might be?"
Because they might come in with a cough, and I might think it's just viral and could go on a long explanation of why they don't need antibiotics.
Meanwhile, they're concerned about cancer, and they walk out without addressing that worry. So while I may have given the accurate diagnoses and treatment, I didn't really address the heart of the patient's concern.
So that's important to tease out, and we as doctors aren't good at doing that.
Take advantage of the hospital's patient advocacy office
Sometimes it's difficult to advocate on your own behalf, especially when you're critically ill. But you can call patient advocates, explain your concerns, and they will go and speak to the providers on your behalf.
It's like getting one employee to go to bat for you, and only for you, as if they had a fiduciary responsibility to you. That's not utilized as often as I think it should be.
Just ask the nurse, or if you're admitted into a hospital, press zero and say, "I'd like the patient advocacy office."
Patients who have someone by their bedside will have better outcomes, it's just proven. Having that patient advocate with you will decrease the likelihood of communication errors and medication errors.
Labeling something "gaslighting" can actually become a self-perpetuating prophecy
Studying gaslighting systemically for research purposes is important.
But for a patient to "diagnose" their provider with gaslighting them is not valuable to the patient, because falling down that line of thinking will ultimately harm your relationship.
I think what's a more valuable tool from cognitive behavioral therapy is to establish "charitable thinking" as a patient.
Instead of assuming that your provider is gaslighting you, even though they may well be, say, "OK, I don't think I'm getting adequate care, so I'm going to assume that the reason this is happening is outside of the provider's control. But I'm still going to try and get the most out of my visit."
Basically, without getting offended — which is very difficult and puts more emphasis on what you have to do as opposed to what the provider really should be doing — say, "OK, I need to ask questions and make it clear to the provider that I still don't understand what's going on."
If you still get shut down, then you have no choice but to look for a second opinion.
But if both parties exhibit charitable thinking, that's where you get the best outcomes.