Richard Titus for Atlantic Health System
My perspective on medical gaslighting is interesting because I am a woman physician, and there are multiple studies that show that we tend to listen more to our patients, we tend to do more counseling, we tend to respond more to our patients in general.
I'm also an African American physician, and there are few of us in the United States.
And so patients often come to our office because of those two factors, and because they feel a kinship that we will sit and will listen to them, we will help seek answers to their questions.
I see it every day: Patients who had joint pains and were told that it was simply obesity or overweight, and it turns out they have some kind of autoimmune disease. Or people who have abdominal pain chronically, and they just needed a particular image and it turns out they had a cancer. That's an extreme example.
The other angle of this, especially as a woman physician and an African American physician, is that we too undergo gaslighting.
When I was interviewing for MD/PhD programs, I was being told that clearly I was just in this for the money because of the background that I came from. I was told that I didn't have the academic strength to be in the field, despite my grades.
Professionally, when I bring up issues related to pay equity or work-life balance, I've been told that I'm just not working hard enough or efficiently enough.
So, we too can empathize with patients about gaslighting, and we too are patients.
I've been dismissed or ignored or treated in a way that was rough.
For example, I likely had fibroids for many years prior to medical school. If you're a little bit younger, then it's, "Oh you probably don't have fibroids" or "you're just busy" or "you gained some weight."
One obstetrician, when I told her about the increase in bleeding, pressure, and pain during my menstrual cycles, insisted that I likely had a sexually transmitted infection. The first time she asked, it was appropriate. But she continued to ask multiple times in multiple ways about my sexual history, and when I clarified that those were not relevant in this instance, she continued to insist.
I was not offered the consideration of an alternative diagnosis, nor was I offered evaluation, like ultrasound, or treatment options, like hormonal contraceptives, for the symptoms.
I managed my cycles on my own until I got to medical school at Howard, where the physicians listened and more fully evaluated my concerns.
Once I partnered with a clinician who actually communicated well with me, I got the answer I needed and the treatment options I wanted.
The physician relationship is a partnership, so it's very important at the outset that both the clinician and the patient establish their expectations.
We wanna know: What are you hoping to accomplish? What are you concerned about? What did you Google?
Then we can say, "OK I hear that, let me hear more about the story, and these are the kinds of tests that we can do to try to answer the question."
If you've felt dismissed in the past, say, "I've been in another practice, I don't feel like I was being heard." That helps us better understand the urgency you feel. It helps us to understand how you prefer to communicate.
So be upfront in the beginning. Say, "I'd like to solve this issue, and if we have time, I'd like to also cover these other issues." That way both of you are on the same page.
The other reason it's important to establish expectations in advance is because we do our research, too.
If you say you're coming in for back pain, I'm looking for old X-rays, physical therapy reports, how your mobility is, whether you've had a colonoscopy or a pap smear. My mind is already doing all of that before you get to the visit.
So sometimes the miscommunication can be that I've done all the prep work for one issue, but then you say, "I also want my elbow and my knee and my head checked out."
I need to say, "OK, I hear these other things are bothering you. Is it OK for us to touch base on that on another day?"
Sometimes patients have an expectation that everything will be done, when that's now how we're trained.
If that was the case, we would just do full-body MRIs for everyone. As soon as someone walks in the door, we would just order everything. But we don't do that.
We're trained to do "if-then" thinking (If you're experiencing this and this, then it could be this. If you're experiencing these three things, then it could be this or this or this.) And then we come up with what's the likeliest thing based on the duration of the condition and previous evaluations.
It's on the clinician to communicate to the patient, "I hear what you're saying. Let's go down this route. If that route is not the case, then we'll go down this route. And if that route is not the case, we're gonna have to bring in specialist care."
If you get to the end of that initial evaluation and you're still not at the answers you need, ask:
Communicate to the doctor how it's affecting you. For example, say:
I can help with that.
I want patients to be empowered to seek the kind of care and the relationships that they want.
There are thousands and thousands of clinicians out there who love what they do, who love helping patients, who love answering their questions and getting those diagnoses, who love helping to prevent disease, who love helping people to overcome their illnesses and get through their illnesses every day.
The 10-plus years we put into just training to be able to do this, almost all of us are doing it because we actually do want to help.
