Dismissing a patient’s concerns can delay proper diagnosis and result in ineffective treatments. In this Prevention article, Taish Malone, PhD, LPC, discusses warning signs of gaslighting and who’s most likely to be affected.
In the 1944 thriller Gaslight, newlywed Paula moves into an old townhouse owned by her late aunt who was murdered years ago. While Paula settles in with a man she met two weeks ago, she soon realizes something is off. Items slowly start disappearing and the gaslights in the attic dim on and off at their own volition. But when she raises the matter to her husband, he convinces her she’s being paranoid.
The film was the first to tack a name to gaslighting. It’s a manipulation tactic to get you to question your beliefs and perception of reality. In Paula’s case, her husband attempted to gaslight her so that they would institutionalize her and he could then gain control of her finances. But gaslighting exists outside of domestic relationships; it’s a common occurrence in the medical community.
What is medical gaslighting?
Medical gaslighting is when a health care professional dismisses a patient’s concerns or symptoms and wrongly blames their illness or symptoms on psychological factors. “You can have doctors convincing you it’s all in your head or to defer to them because they’re the professionals,” explains Taish Malone, L.P.C. Ph.D., a psychotherapist and counselor at Mindpath Health.
Most of the time, doctors are not intentionally trying to gaslight and may not even know they are doing it. While doctors have trained for years to become experts in their field, they’re still human and can occasionally make mistakes. “Physicians aren’t without biases. Patients have to advocate for themselves when they feel there is a health problem,” adds Christine Metz, Ph.D., an endometriosis researcher at the Feinstein Institute for Medical Research.
Intentional or not, medical gaslighting carries grave consequences. It can delay someone from getting the correct diagnosis, have people endure unnecessary or ineffective treatments, and create mistrust for future medical decisions. Sometimes, Dr. Malone says you might be seen as a hypochondriac—a person with an intense fear of being or possibly becoming extremely sick—and have notes in your file that might make other doctors think you’re just a difficult patient.
Medical gaslighting is real, and when your concerns are being brushed aside you may feel alone in your pain. Ultimately, you’re the expert of your body and your health concerns are always valid. Being aware of the power of gaslighting is the first step to addressing it and getting the help you deserve.
Who’s more likely to experience medical gaslighting?
Anyone can fall for medical gaslighting, but it’s more common for women. “It’s often associated with misdiagnosis; doctors misdiagnose approximately one in seven patients. But that happens more commonly among women than men,” says Metz.
Research suggests women are 50 percent more likely to be misdiagnosed after a heart attack and 33 percent more likely to have a wrong diagnosis after a stroke. Additionally, women are often misdiagnosed or experience a delayed diagnosis in people with autism spectrum disorder. Another study compared the medical outcomes of men and women who came to emergency rooms for stomach pain and found that women were 33% more likely to wait longer than men and receive less pain relief medication despite having similar symptoms.
People with reproductive health problems
Of all the fields, however, Metz says most cases of medical gaslighting involve cases of reproductive health. “Many people don’t want to talk about menstrual pain, they don’t want to talk women’s reproductive health because it’s a taboo in society and people feel uncomfortable talking about it,” she explains. “There are also biases, habits of the mind, such that they [rarely] believe that women’s sensation of pain is that strong.”
Metz is currently running the ROSE clinical study where she studies better ways to diagnose and treat reproductive health disorders such as endometriosis. Among her findings, she found that over 70 percent of women had their symptoms disregarded by friends, family, and physicians.
Women may also have a habit of normalizing their pain and symptoms, especially if it’s been experienced by other people in the family. For example, Metz says that for conditions like endometriosis, “it’s very common for the mother to say to their child ‘I went through that, take your Tylenol and rest in bed for an hour to feel better,” she notes. “They normalize what they experienced even though within societal norms, it’s not normal.”
Young children and teens
Age also plays a role in a person’s risk of medical gaslighting. Metz says society has taught us to minimize adolescent health concerns as part of puberty or something you would age out. When in fact, menstrual pain or exhibiting unusual behavior could be a sign of something more serious like endometriosis or a mental health condition.
People may also experience unconscious biases when receiving a medical diagnosis. For example, people of color are more likely to be considered defiant and diagnosed with disruptive behavior disorder than ADHD compared to their white peers. Dr. Malone says that across all groups, women and people of color are the ones most likely to have their symptoms dismissed and experience medical gaslighting from their providers. “Many doctors do not understand the disparities in client care,” she explains. “There are misconceptions that can come from training or biased beliefs about certain cultures.”
A delay in diagnosis because a doctor is not taking your symptoms seriously could prevent women of color from receiving life-saving treatment. A 2015 study in the Journal of Women’s Health found that African American women have a two month longer diagnosis delay and surgical treatment of early stage breast cancer than white women.
People who are overweight or with obesity
Research suggests there is weight bias in medical care. A 2019 review looked at past studies on people with obesity’s experiences when going to the doctor and found that doctors regularly dismiss their symptoms. Common experiences included doctors carrying patronizing and fat-shaming attitudes and doctors making assumptions based only on a patient’s size rather than their health concerns. What’s more, people who are overweight or with obesity are more likely to feel like they aren’t heard by their provider. The 2019 review found that people who felt stigmatized for their size often delayed medical care, and when they would go to the doctor, they saw multiple providers.
What are the signs of medical gaslighting?
Medical gaslighting can take on many forms. The major sign of medical gaslighting is when your doctor downplays your symptoms or does not believe you. Your medical provider can do this in the following ways:
- Not engaging or listening to the conversation
- Not writing down your concerns or asking follow-up questions
- Make it difficult to get a referral or make up excuses why they cannot give you one
- Does not wish to discuss symptoms with you
- Interrupting or shutting down your complaints or concerns
- Tries to convince you it’s all in your head
- Blames you for your symptoms (such as obesity, stress from work, being on your period)
- Forcing you to argue to be heard and taken seriously
Dr. Malone says that medical gaslighting among women or African Americans can also come as generalizing speech. If the doctor dismissed your concerns as something that stereotypically happens in a group of people, then Dr. Malone says it’s a sign that your doctor hasn’t looked at you as a person rather than an overgeneralized statistic.
What can you do to prevent medical gaslighting?
There are steps you can take to stop medical gaslighting. The first is addressing the issue, although standing up for yourself might feel daunting at first. “It takes a strong person to say to the physician that your symptoms are real,” says Dr. Metz. She says something as small as ‘I don’t appreciate you telling me this is all in my head’ or ‘please don’t explain to me how I feel’ can make a real difference in steering the conversation in your direction. Once your feelings have been acknowledged, it’s important to define the purpose of the visit and what you’re hoping to get out of it—whether it’s a referral or a diagnostic test.
Having documentation—from detailed observations you’ve jotted down in a notebook, tracking symptoms in a calendar, or photos of clinical symptoms—can help when advocating for yourself in front of a doctor. Your notes and medical history can help to start the conversation by talking about when you first started seeing signs of pain or other symptoms, any potential triggers, and how long the symptoms last.
Preparing a list of questions you want to discuss ahead of your visit (and readying yourself to ask follow-up questions) is another way to keep the topic focused on your concerns. “It’s very easy to forget what you’re going to say when a doctor dismisses your concern because it’s a little shocking,” explains Dr. Metz. “But if you have your little checklist in front of you, it’s more difficult to forget it what you want to ask or say.” Because doctor’s are usually pressed for time with back-to-back appointments, start with the most important questions you want answered.
Both experts recommending bringing a support person like a spouse or a best friend. They can help to speak on your behalf if you’re not able to properly voice your concerns or be there to take notes. Even having their presence as emotional support can make a difference in feeling reassured that your concerns are important. If you’re in the hospital or undergoing a medical procedure that might have you incapacitated, Dr. Malone recommends appointing a family member or trusted friend to act as a healthcare proxy in case you’re on strong medication or cannot speak for yourself when a doctor is going over your plan.
When in doubt, get another doctor to take a second look at your case. You might feel like that’s going behind your doctor’s back, but Dr. Malone says it’s important to be your own advocate for your care. Always seek a second opinion if you feel like your provider did not fully understand you or give a good diagnosis.
What should you do if you aren’t getting the help you need?
If you’ve exhausted all your options or do not want to deal with a gaslighting doctor, both experts agree in switching providers. “If your pain interferes with your day-to-day activities, and your life goals, you have to do something about it. You shouldn’t give up on yourself,” says Dr. Metz.
Read the full Prevention article with sources.
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