(Blog by Claire G and originally appeared on Through the Fibro Fog website)
Had I just been a victim of medical gaslighting as a woman seen by a male doctor? The thought whizzed through my mind as I almost stumbled out of the consulting room trying not to cry and headed straight to the reception desk to ask to see a different, trusted, doctor.
Why the question? Well, medical gaslighting can often be confusing and complex, and perhaps even unclear. How we are treated by a doctor can be bound up in medical language, as well as looks, raised eyebrows, silences even, that all convey something, but we aren’t always sure what. Was it a gendered response? One bound up in power relations? Or was I being over-sensitive? One thing I knew for sure was that it wasn’t the latter.
What is medical gaslighting?
As described by health.com, “gaslighting” happens when one person tries to convince another to second-guess their instincts and doubt their perception that something is real. Medical gaslighting happens when healthcare professionals downplay or blow off symptoms you know you’re feeling and instead try to convince you they’re caused by something else — or even that you’re imagining them.
I doubt there are any official figures of its prevalence, and if there are I can’t locate them, but those in the chronic illness community certainly know how common it is. Instagram Twitter, Facebook, and more are filled with stories of such behavior and its traumatic impact. It runs worryingly deep through the medical system — so much so that often patients enter an appointment expecting not to be believed. We anticipate that we will have to fight to be heard, and treated accordingly.
An experience of medical gaslighting
I went to my usual doctor about an issue, and he suggested I seek a second opinion in case he had missed something. I respect that suggestion; it shows he understands that no doctor is fallible. Ego was left at the door, and he put my care first to check the issues. So I made an appointment with the head GP for my doctor’s surgery.
It began well. Friendly, polite, as it should be. Then something went awry. I spoke of the issue and he didn’t examine me. Instead, he told me he couldn’t see a problem. I pointed out that maybe he wouldn’t be able to visually see it, but he could feel it. I needed a physical examination, not a visual one. It spiraled quickly. He refused, but without actually saying no. I got looks, contemptuous remarks and he spoke down to me. When I said I could complain about his behavior, he sarcastically said that was my right and to go right ahead.
How can we know if a situation was one of medical gaslighting?
In hindsight, it isn’t difficult to pinpoint moments of medical gaslighting in that appointment, but at the time it felt hazy and uncertain. I knew that he was downplaying, refusing even, that I had an issue. He said he couldn’t see it. Refused to examine me. Except he didn’t outright say no. He just didn’t, wouldn’t do it. I got silence when I said that is what needed to be done.
Medical gaslighting can be obvious at times. It can be an outright refusal to acknowledge the symptom the patient describes to a doctor or a downplaying of the severity or frequency of symptoms. It can be suggesting that the patient is exaggerating, often said in careful words so as not to actually use the words “exaggerating” or “making it up.”
Other times medical gaslighting can be harder to identify. Communication isn’t just through spoken words. It can be a condescending sigh, a raised eyebrow, a silence after a question the patient asks. Those forms of communication aren’t noted on our medical records, aren’t recorded in any way. If raised, perhaps it will be said the patient was mistaken. After all, such gestures lack concrete meaning and may be subjective in their interpretation by another.
I feel as though I am going to use the words “complex” and ‘challenging’ a great deal in this post. Yet medical gaslighting often is. It’s not clear-cut at times, or certainly not in a way that could be proven. I think the patient usually knows though. They sense it, feel it, get understandably angry by it.
The “it’s all in your head” line
For those in the chronic illness community, the sheer number of patients who are told their symptoms are “just” anxiety won’t be a surprise. Dysautonomia International describes that “prior to being diagnosed with POTS, 59% of patients were told by a doctor that their symptoms were ‘all in your head.’” In my experience, the same was true for vestibular migraines. Others have said they had the same experience in regards to endometriosis.
This is also an area of complexity. Of course, many people do have anxiety. It is a challenging condition that requires medical support and treatment. It certainly isn’t a lifestyle choice or a trendy “thing to have,” as some in society seem to believe. When it comes to a diagnosis of a chronic condition, the link (or not) to anxiety can be a diagnostic challenge. Does the patient have anxiety or another condition with similar symptoms? A racing heart, dizziness, feeling faint, nausea, and more can be symptoms of anxiety, but they can also be symptoms of POTS, for example.
When such symptoms are described by the patient, it is time for the doctor to undertake a thorough medical history, ask questions, perhaps conduct a physical examination depending upon symptoms, and refer for tests if required (which it often is). Falling back on “it’s probably anxiety” without due regard for other possibilities is lazy medical care.
And of course, chronic illness conditions and anxiety are further complicated by cause and effect. I felt as though I may as well bash my head against a consulting room wall on one occasion when I said, over and over, that it was the symptoms of vestibular migraine that were making me anxious, not that anxiety was causing the symptoms. I walked out of the room knowing I hadn’t won that “fight,” and angry that my experience had been sidelined for a pre-conceived view of the relationship between chronic illness and anxiety.
What is the impact of medical gaslighting on the patient?
Medical gaslighting delays a diagnosis, simply put. That delay then of course delays appropriate treatment. It leaves the patient in pain, or with other symptoms longer than necessary. It may mean that their health spirals into greater issues, potentially in an irreversible way.
The impact of medical gaslighting also has a psychological element. It is traumatic not to be believed in your pain. We go to doctors for help, care, and hopefully for some empathy and kindness in treating the issue at hand. To be disrespected by the very people who are supposed to put your needs first is distressing (to put it mildly). It leads to a distrust of doctors at times, something that can prevent patients from seeking help for further health issues.