For years, 28 year old Carlie had been going to doctors, telling them about her painful periods, constipation, anxiety, and painful sex. Each time she was told the same things: take the Pill, use a laxative and eat more fiber, try an anti-anxiety medication, relax and try more foreplay before sex. She was already embaressed enough by her symptoms. She felt incredibly self-conscious that her bloating made her look and feel pregnant, and she didn’t have the confidence to tell her partner that sex hurt – so she endured more discomfort than she felt very good about.
A self-declared feminist, this was all very eroding for her self-concept. So having to repeat her symptoms for doctors who dismissed her again and again, as basically an anxious and uptight millennial,, made her even more so. Sshe had no answers, and worse, she began to wonder if she wasn’t really just anxious and uptight. After all, that could cause painful sex and digestive problems, right? .
But she still trawled the internet, hoping to find an answer. Then, after reading one of my online articles about endometriosis, the lights went on – and she found a gynecologist willing to go down that discovery road with her. Sure enough, she did have endometriosis – a diagnosis and story she shared with me, and with great relief.
Variations of this story – and some with far worse outcomes – repeat themselves daily – even hourly – in doctor’s offices and hospitals around the country. A woman is told that her mid-menstrual cycle pain is normal when, in fact, she has an ovarian cyst. Another that her chronic pain is due to lack of exercise and being overweight, leading her to feel blamed and shamed, rather than being properly diagnosed with fibromyalgia. One that her fatigue is “just stress” until she’s finally (hopefully!) diagnosed with an autoimmune disease. Another that her low postpartum mood is “just the baby blues, it will pass,” when she actually has debilitating postpartum depression. And yet another is sent home from the ER mid-heart attack with an improper diagnosis of anxiety, and anti-anxiety meds.
You may already be shaking your head, having known a woman to whom something like this happened – or it may have happened to you. If you’ve been made to feel by health care providers that your symptoms are not that bad, or normal, or could be “all in your head,”—whether just stress, anxiety, or overwork—you’re not alone. I’ve heard this story—and witnessed it myself—countless times during my years of practice.
And the evidence bears this out: It can take years – even up to a decade – for a woman to get diagnosed with endometriosis, an autoimmune condition, or PCOS, common conditions all affecting as many 1 in 8 women. Many never get an answer, and most have spent some amount of time assuming maybe it is ‘just in their heads.’
What’s happening in all of these scenarios? In very recent years, it’s become clear that one common thread is something called “medical gaslighting,” an increasingly used term for the well-documented phenomenon of patients—almost universally women—having their symptoms, many suggestive of very diagnosable and real medical condition, small and big – minimized or outright dismissed by medical professionals.
Medical gaslighting is not just psychologically uncomfortable to experience – though it definitely is that. It can be a matter of life and death as a result of dangerously delayed or missed diagnoses for serious conditions, including heart attack, as we’ll explore.
And as I have already illustrated, It can cause women to start to “gaslight” themselves, wondering if they are, in fact, convincing themselves of symptoms that aren’t there—even severe pain! As one woman, who was eventually diagnosed Hashimoto’s (autoimmune hypothyroidism), told me after years of her weight gain and low mood being chalked up by several doctors, none of whom ran proper blood work, to depression and her poor food choices, “Surely all these doctors couldn’t be wrong; after all, they were the experts.” Too often, in the face of medical gaslighting, we start blaming our bodies and ourselves.
Another major risk of being medically gaslighted is that we lose trust in the medical system and stop seeking medical care when we do have symptoms – sometimes even serious symptoms. Medical gaslighting by a previous health care provider is a major reason women come to see me in my practice. We all want to be seen, heard, believed, and properly diagnosed; we also don’t want to be made to feel ‘crazy’ anymore.
What is (Medical) Gaslighting
Prior to the advent of electric lighting, homes were lit by gas lamps. The wealthy had homes with gas sconces that could be, with the turn of a small knob, be adjusted for brightness. The term “gaslight” stems from a 1944 American psychological thriller film starring Ingrid Bergman. In the story, Bergman's character, a young woman who has inherited her aunt’s fortune, unknowingly marries her aunt's former lover and get his – her murderer – who is after her inheritance, including a valuable piece of jewelry that he believes is hidden in their home.
Early on in the story, Bergman notices strange occurrences in the house, strange noises in the ceiling, valuable items in the house being displaced or disappearing, and toward the term gaslighting, the gaslit sconces mysteriously dim and brighten without anyone apparently adjusting them.
Her husband, whom she of course, adores, repeatedly denies that these phenomena are occurring, claiming she's imagining things and eventually he assers that she's medically insane.
Ultimately, a police inspector (and yes, the handsome hero!) confirms her suspicions: Her husband is up to something nefarious. He also sees the gaslights changing in brightness, and assures Bergman of her sanity. A chase ensues and results in her husband being detained – tied to a chair, in fact, prior to arrest. The denoument of this remarkably still relevant film is a suspenseful moment where Bergman get hers: She taunts her soon-to-be imprisoned and soon to be ex-husband with a knife while he's tied to the chair, telling him perhaps the knife is real, perhaps it is not. Touche.
The term “gaslight” eventually began to appear in academic settings, referring to a form of psychological manipulation in which someone seeks to undermine another person’s perceptions of reality, causing the victim to question the validity of their own thoughts, feelings, or memories. Apropos, and like Bergman in the film, gaslighting typically leads victims to feel confusion, loss of confidence and self-esteem, and uncertainty about one’s mental stability. I learned of the term – and the movie – about 20 years ago, when my very cool hypnotherapist older cousin (thank you Jules!) told me about them. As dated as the film is, I deeply recognized the phenomena as one I’d seen happen far too many times in health care – and in other ways in women’s lives, for example, in emotionally abusive relationships.
In recent years, the gaslighting has become far more mainstream, and is used more liberally than in its original academic form , to refer to “grossly misleading someone, especially for a personal advantage.” The term has become so ubiquitous that in 2022, the Merriam-Webster dictionary chose gaslight as their “word of the year.”
More recently, the term “medical gaslighting” has found its way into common parlance on social media and even in places like the New York Times, to describe the increasingly documented reality – and shared experience of women– in which doctors (or other medical providers) dismiss symptoms or brush women’s symptoms off as psychological, or as ‘not that bad’ or as not existing at all. Or the woman’s symptoms may be acknowledged, but she is told she is fine, doesn’t have any medical issues, or that her symptoms probably aren’t as bad as she thinks.
In most cases, medical gaslighting is likely not an intentional motivation on the part of medical providers to manipulate or deceive a patient; it is more likely an unfortunately baked in part of medical training that leads to poor communication, and a hierarchy in which the doctor believes he or she knows best and that the patient is an unreliable reporter. This is not uncommon in our culture in general – we can all think of high-profile crime cases in which women are not believed, and women not being trusted is a common and old cultural trope.
But even without ill-intent, the consequences of denying the reality of someone’s symptoms and experience can be damaging – even devastating. Serena Williams' now oft-cited birth experience is a stark example of this issue. In 2017, the tennis superstar gave birth to her daughter, Olympia, via an emergency cesarean section. Despite her clear and well-founded concerns about her health due to a history of blood clots, Williams encountered resistance from her medical team. During her postpartum period, Williams experienced shortness of breath and requested a CT scan, believing she might have a pulmonary embolism, consistent with a known medical condition she has. However, the medical staff initially dismissed her concerns. It was only after she insisted on the test that a blood clot was indeed discovered in her lung. This delay in diagnosis could have had fatal consequences.
Williams' experience highlights the pervasive problem of medical gaslighting, where patients, especially women and women of color, are often not taken seriously when they express their symptoms or concerns. The consequences can be dire, as delayed or incorrect diagnoses can lead to severe health complications or even death. It underscores the urgent need for healthcare providers to listen to their patients, prioritize their concerns, and ensure that every voice is heard in the pursuit of accurate and timely medical care. And until that’s what’s baked into health care, it requires us to be vigilant to the possibilities in our own medical encounters, and to know what we can do to protect ourselves and our health, if it occurs.
Beyond the Myths of Hysterical, Drug Seeking Women
The fact is that medical gaslighting happens primarily to women, and even more so to women with chronic conditions and symptoms that are historically attributed primarily to mental health issues, including depression, fatigue, or chronic pain. Women from specific demographics are also more likely to be gaslighted – told their symptoms are due to hidden agendas. For example, Black women are highly vulnerable to having their pain dismissed because they medical providers are more to be stereotypes as drug seekers. This is not a theoretical phenomenon. As a doctor working in hospital, I’ve had to intervene more than once when a doctor or nurse refused adequate pain medication from a Black woman in asickle-cell crisis or experiencing pain from end-stage ovarian cancer. The rebuff to me, from nurses and other doctors, as I was taking over care in each case was the same: She’s probably just drug seeking.
Bullshit. These women were demonstrably sick, and with conditions that are known to cause severe pain.
Women who are overweight are also especially likely to experience medical gaslighting. One patient of mine told me that her former doctor had said that if she just did a better job of “controlling her fork to mouth problem” she’d lose weight. In fact, she had severe and undiagnosed Hashimoto’s.
But it’s not just these women; every woman is at risk. One study found that women who had pain, but who dressed up nicely for a doctor’s appointment, were more likely to be dismissed as not in pain – because if she was, clearly she’d not be able to dress up like that. And then the opposite also found to be true. Women who dressed in sweats, for example, and didn’t put on makeup or do their hair up, were more likely to be considered drug seeking and have their pain dismissed because of that. A lose lose if you ask me.
So why is this happening? And happening so much to women?
Perhaps the most common reason is persistent, outdated gender stereotypes. Cultural norms portray women as complaining, and medicine happens in the context of the greater culture. If women are seen as complaining, this may lead medical providers (as well as others) to underestimate women’s reports of pain and other symptoms. Cultural portrayals of women as more emotionally expressive leads providers to wonder whether women are exaggerating symptoms, or using symptoms as an excuse for a day off of work, medication, or other benefits. On the flip side, and despite all of our experience with “the man flu” men are considered more likely to be stoic, so when they express pain it’s more likely to be real; when we express it we’re more likely being ‘dramatic.’
In a groundbreaking 2001 article called “The Girl Who Cried Pain,” researchers reported that because of these gender stereotypes, women “are more likely to have their pain reports discounted as ‘emotional’ or ‘psychogenic’ and, therefore, ‘not real.’”
Research also suggests that all of us, men and women, tend to hold these unconscious biases. A 2021 experiment in which people watched video clips of real patients in pain found that, compared with the patient’s own rating of their pain, observers (of both genders) underestimated women’s pain and overestimated men’s pain. When men and women showed the same amount of pain in their facial expression, women were judged to be in less pain than men. The observers also thought that the female patients would benefit more than male patients from psychotherapy than medication. The researchers were able to show that gender stereotypes seemed to be driving this bias: those who thought that women were more willing to report pain than men tended to underestimate women’s pain the most.
Another reason that women’s reports of their pain and other symptoms are often dismissed as psychogenic is simply that doctors have long been taught that women are especially prone to “hysterical” symptoms. In ancient Greek medicine, the disease hysteria, stemming from the Greek root word for uterus, was originally believed to arise from a ‘wandering womb'—that is the uterus losing its moorings in the pelvis and wandering around the body, causing everything from melancholy to madness. Eventually, in the 20th century, hysteria came to be considered a mental disorder that caused physical symptoms—and the typical hysterical patient was always a woman.
Hysteria was an actual diagnosis that appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until the 1980s. And many common women’s health conditions were blamed on women’s psyches and personalities for decades before they were finally recognized as very real biomedical conditions. For example, women with migraines were described as having a “migraine personality,” meaning “neurotic,” “frigid,” and unable to accept their “womanly responsibilities.” Meanwhile, endometriosis was referred to as “the career woman’s disease,” because it was thought to affect women who were “intelligent, compulsively perfectionist, anxious, and willing to place personal achievement over having children.”
While hysteria is no longer a diagnosis in the DSM, the concept remains alive and well—now covered by terms like somatization, functional symptoms, and “medically unexplained symptoms.” The belief that women are more likely to have psychogenic symptoms persists today. Doctors far more commonly default to a diagnosis of psychologic origin in women than in men. Usually, we are no longer directly told it’s “hysteria” or that it’s “all in your head”—although a Latina woman told me that, upon hearing she was having chest pain, her doctor told her that she was a “hysterical Cuban woman.”
Instead, women are now often told their unexplained symptoms are depression, anxiety, or stress. And if you happen to tell your doctor that you’re under stress or that you’ve had a mental health challenge in the past, this just increases the likelihood that your doctor will chalk your current symptoms up to being psychogenic. Women who have a mental health diagnosis in their chart—anxiety or depression, for example, which is now the case for about 1 in 4 women—are significantly more likely to have their physical symptoms written off as psychological in origin. And a woman who goes from doctor to doctor, trying to get answers, or even more egregious, saying her previous provider didn’t give her any answers, is even more likely to be labeled as ‘difficult’ and to have a psychological diagnosis applied, rather than her actual symptoms explored.
In addition to having their symptoms psychologized, it’s also common for women to have their symptoms dismissed as normal, thanks to an equally long history of normalizing women’s pain and illness. As women, even we ourselves often buy into the cultural myth that suffering is an expected, inevitable part of being a woman, assuming it’s just normal for us to experience hemorrhagic-level periods, severe monthly cramps, or fifty soaking hot flashes a day. And doctors often reinforce this myth. They tell women who report pain with sex to just relax more or have a glass of wine first (not kidding here – this is a common “prescription”). And assure women with debilitating menstrual pain from endometriosis that it is just “normal” period cramps. And blame a wide range of symptoms on women’s “hormones” with no further investigation.
Black women and overweight women, as I mentioned, are also far more likely to be gaslighted. This is based on biases that run deep in our cultural history and in the history of medicine, and which are still pervasive today. In addition to the trope of the drug-seeking Black person, or Black woman, there’s a widely entrenched belief that Black women are more pain tolerant than just about anyone else. Ths is based on horrible myths perpetuated by slavers, that justified physical abuse, and also sexual abuse, of enslaved Black women. And the fat-shaming so ubiquitous in our culture at large, is also alive and unwell in medicine, made worse by the mistaken beliefs that being overweight is the root of all disease. It is not, and I will talk about this in another episode. What I will state here is that studies have shown that the majority of doctors queried in various surveys admit that they feel disgust for overweight patients, and consider their weight, and co-occuring medical problems, the patient’s fault.
Women are also gaslighted more often than men because of a much greater lack of knowledge about women’s bodies and health conditions. Until the 1990s, women were systematically excluded from clinical research. Even now, conditions that mostly impact women continue to be under studied due to lack of funding. We now know, for example, that women often don’t experience the stereotypical symptoms of a heart attack – the chest pain that leads to the ‘clenched fist sign’ over the heart; the arm pain. The symptoms are more prevalent in med. Women’s heart attack symptoms may present as fatigue, nausea, jaw or shoulder discomfort. If doctors aren’t educated on these differences, they are likely to dismiss women’s unexplained symptoms.
This happened to Carol. Carol had been unusually fatigued for several days when she finally came into hospital. I happened to be working night on the ED as an internal medicine resident when she came in. When I reviewed her symptoms to the attending physician, and expressed my concern for heart attack and the need for a workup, he told me that given that she had no chest pain, I should just send her home. I essentially begged him to let me keep her for a few hours for observation and to run some tests that rule in or out a heart attack. He relented, and I ran a cardiac enzyme profile. Sure enough, she was in the early stages of a heart attack and received the potentially life-saving treatment she needed as a result. All the attending said to me was, “Nice catch.”
The Consequences of Medical Gaslighting
It was only because of my extracurricular studies that I knew that women’s symptoms of heart attack may not be the typical ones men experience. Any other doctor may have sent Carol home as an ‘anxiety case.’ And this wasn’t a one-off I happened to witness. Indeed, women are more likely to die of a heart attack than men, because our symptoms are more likely to be missed – and dismissed as psychogenic. A 2022 study found that, compared to men, women who visited emergency departments with chest pain were less likely to be triaged as an emergency, to undergo electrocardiography testing, be seen by a specialist, be given medications for a heart attack, or be admitted to the hospital. In another experiment, women were twice as likely as men to be diagnosed with a mental health condition when they reported symptoms of heart disease.
This highlights the most dangerous potential consequence of medical gaslighting: That too many women do not get properly diagnosed and therefore treated for a serious condition. Indeed, research shows that women are more likely to be misdiagnosed than men in a variety of situations, face longer diagnostic delays for a range of conditions—from cancer to autoimmune diseases—and are often treated less aggressively for their pain and other symptoms. In acute, potentially fatal conditions, when time is of the essence, medical gaslighting can literally kill.
Here are just a few examples of studies that illustrate this further:
- A 2020 study found women and girls were also more likely to have a missed appendicitis diagnosis in the ER.
- In a 2008 study of patients coming into the ER with abdominal pain, women waited 16 minutes longer on average than men (65 minutes versus 49 minutes) to receive pain medication. The women were also less likely than men to receive any pain medication at all, especially opiates.
- A 2014 study found that women were a third more likely than men to have a missed stroke diagnosis—meaning they’d come into the ER suffering a stroke and been sent home with a misdiagnosis or no diagnosis at all.
For more chronic conditions, medical gaslighting can go on for years, as women go to doctor and doctor seeking answers for their ongoing symptoms.
Take endometriosis. While the painful condition is estimated to affect 10 percent of reproductive-aged women, it takes many patients over a decade to get properly diagnosed. In one survey of over four thousand women with endo, nearly two thirds had been told prior to diagnosis that “nothing was wrong with them.”
Or consider autoimmune diseases. About 80 percent of autoimmune patients are women. In fact, autoimmune diseases make it into the top ten killers of women annually. Yet according to a survey by the Autoimmune Related Diseases Association, it takes an average of 4 years and 4 doctors to get a diagnosis of a serious autoimmune disease, and many patients report being labeled “chronic complainers” during this diagnostic delay.
And even though most autoimmune diseases affect more women than men, it often takes women with autoimmune diseases longer to get diagnosed compared to their male counterparts. One study of patients with rheumatoid arthritis found that women were referred to a rheumatologist in 10 weeks, compared to just 3 weeks for men. While another survey found that women were diagnosed with Crohn’s disease in 20 months, compared to 12 months for men.
Beyond the physical health consequences, being medically gaslight—especially repeatedly—can cause deep emotional harm. Having your bodily experience invalidated by a medical professional, someone you’re dependant on for help, can be very traumatic—and can sometimes even result in PTSD. For example, in a 2020 survey of lupus patients—an autoimmune disease that affects mostly women—a majority described being dismissed or disbelieved and some described developing PTSD, usually from cumulative negative medical experiences, especially misdiagnoses. Understandably, these experiences had made them distrustful of the medical system—and sometimes led them to avoid seeking care even for potentially life-threatening symptoms.
I’ve seen this first-hand in my practice. When women come to me after being gaslighted by other providers, they are so greatly relieved to learn that they did not imagine their mistreatment – or theur symptoms which so often they begin to worry, like Bergman in the film, that perhaps they had imagined them after all. When we find the actual diagnosis, which we often do, they are doubly relieved to have an explanation for their symptoms. “I knew something was wrong,” I’ve heard so many women say. But even when we don’t find a diagnosis, as sometimes symptoms remain mysterious, they are validated and believed, and that in itself, is a relief. . The validation that she’s not “crazy” is often the first step in reclaiming her power and confidence.
Medical Gaslighting Can Happen to Any of Us
Years ago, I had my own encounter with medical dismissal. It unfolded over several years, beginning at the age of 35, when my once-stellar exercise tolerance inexplicably plummeted. Despite my pristine health and general physical fitness, over the course of several months, after an unexplained flu-like illness (in mid-summer), uphill exercise on my bicycle, once relatively easy and something I loved, turned into literal uphill battles. So did hiking up a steep grade, something I’d previously been able to do toting a toddler in a backpack. My heart would pound in my chest, feeling like it was going to explode, nausea and dry heaving would overtake me, and my pulse would thunder in my ears. I would teeter on the brink of passing out. I would have to stop, rest, and let symptoms subside for several minutes before continuing, and sometimes I just couldn’t continue. It was uncomfortable, embarrassing, and discouraging. With no answers forthcoming other than stress (not!) I learned to work around the symptoms by avoiding strenuous uphill exercise, or to pace myself very slowly when I did attempt it.
Then, during my medical training a couple of years later, a series of life-and-death ‘codes’ unfolded before my eyes. Picture Grey's Anatomy-esque scenes, “Code Blue, Code Blue” blaring on the hospital PA system, with doctors rushing to resuscitate dying patients. And I was one of those doctors. On these occasions, adrenaline filled, I often had to sprint up six flights of stairs or race the length of the hospital’s city block length to reach the code. On two such sequential occasions over the course of a few days, I was on the verge of collapse before I got there, and on the third, I nearly fainted outright, prompting a rapid response at the hospital. I basically became the code on the way to a code!
In the emergency department, where I was told to go just to be extra cautious, after some rest, water and orange juice plied into me revived me, a charismatic and, okay, I’ll admit it, very hot-dad-cardiologist (as in he had 4 kids and had major swag), seemingly straight out of a rom-com, diagnosed me as being overheated, dehydrated, and overworked, pointing fingers at my demanding life as a mom and medical student. But, “No,” I protested, “I never had these symptoms before the last couple of years – and it’s very specific. Something just isn't right.” Undeterred, he dismissed my concerns. “I have 4 kids too, Dr. Romm, so I know what pressures you’re under,” he said in an attempt-at-soothing voice. It almost worked. But trusting my instincts, and not liking having just basically crumped on a medical rotation, I sought a second opinion. One of my medical professors – also a cardiologist, who upon hearing my story, was clearly amused and agreed to see me.
It was after a near-collapse on a treadmill during an exercise stress test, and reviewing my ‘echo’ results (echocardiogram) that he returned to the room, actually chuckling. On a first name basis with our professors at my medical alma mater (Yale), I asked him what he thought was so funny! His response? “I thought you were just another hypochondriac medical student having whatever symptoms you hear about on your rotation. But, Aviva, I was wrong; It turns out you have a very real electrical conduction issue in your heart. If you want to play Wimbledon, he said, you can get a pacemaker. Or adapt to it.” I don’t play tennis with any seriousness or skill, so I figured I didn’t need to worry about Wimbledon – or the Tour de France, so I’ve lived relatively comfortably with my personal odd electrical cardiac variation for many years now. I take it slow and steady, and I finish the race. The cause ? Lab tests later suggested that the flu-like illness may have been Lyme disease.
The reality here is that I’m a generally confident woman with a lot of experience public speaking with access to medical care, and an MD after my name does help me communicate in such situations. As I talk about in my podcast and article How Being a Good Girl Can Be Hazardous to Your Health, I also learned early how to advocate for myself and have seen far too many situations where lack of advocacy for someone in health-care need didn’t end well. My decades of experience as a midwife in a state in which midwifery was illegal and had the lowest maternal mortality rates in the US (still is, still does), definitely fuels my fire as a fearless advocate for anyone experiencing injustice – including – LOL – myself,
But just being a doctor doesn’t necessarily protect one from medical gaslighting. We only have to look at the stories of Susan Moore, MD, and Dr. Angela Marshall, author of Dismissed: Tackling the Biases that Undermine Our Healthcare, who I interviewed for my On Health podcast, who was dismissed by another doctor over turned out to be very accurate concerns over her infant son’s health. Susan Moore was a 52-year old black, female physician, whose severe breathing symptoms when she was being treated for COVID, along with neck pain, were dismissed. She reported this dismissal in a poignant Facebook video, and stated, “I was crushed. He made me feel like a drug addict. And he knew I was a physician. I don’t take narcotics,” Susan died of untreated COVID complications shortly after.
And Serena Williams won Wimbledon – 7 times – and that didn’t stop her medical team from dismissing her. It just gave her the confidence to speak up. And that’s what I want to instill in you, today.
How to Recognize Medical Gaslighting
As I’ve shown you, medical gaslighting is a deeply embedded and deeply concerning phenomenon, connected to sexism, racism, and also affects others (overweight people, non-binary folks, older people, and those with physical and cognitive disabilities, or mental health challenges) that can erode trust in the patient-provider relationship and hinder accurate diagnosis and treatment. It leaves individuals feeling unheard, doubted, and even questioning their own health experiences – and mental competence!
Recognizing the signs of medical gaslighting – whether it’s happening to you, someone you love, or you’re a medcal provider witnessing or hearing about it – is the first step towards ensuring that it doesn’t interfere with proper medical attention and care.
Here are 7 signs that could indicate medical gaslighgting, dismissal, or disrespect:
- Symptom Dismissal: Healthcare professionals dismissing your symptoms and failing to take your concerns seriously.
- Lack of Listening: Healthcare providers not actively listening to you or frequently interrupting your attempts to explain your condition.
- Belittling Your Concerns: Scoffing or laughing at your concerns or suggesting that your symptoms are purely psychological, implying that they are “all in your head.”
- Lack of Empathy: A lack of empathy or sensitivity towards your pain and worries, making you feel unheard and invalidated.
- Blaming the Patient: Placing blame on you for your medical condition, rather than conducting a thorough investigation into its causes.
- Mental Health Attribution: Attributing the cause of a medical issue solely to a mental health condition, without considering other possibilities.
Now let’s talk about what you can do if you spot any of these happening in a medical care experience.
How to Advocate for Yourself to Avoid Medical Gaslighting
First and foremost, trust yourself and your instincts. That’s perhaps the hardest part because not only is gaslighting baked into the practice of medicine as it exists today in the US, so is distrusting ourselves- which is exactly what gaslighting perpetuates! Get the problem here? So again, trust your instincts and how you feel.Believe me, I know that it can be hard to speak up to our doctors. As women, we’re socialized to be “good girls”—we do not want to be perceived as difficult, complaining, or unappreciative. For more on overcoming good girl conditioning, check out my podcast “Being a Good Girl Can Be Hazardous to Your Health.” If you’re scared of conflict, create an alter-ego who is not afraid of it and channel her. I talk about doing that in “How to Talk to Your Doctor and Get the Health Care You Need. If conflict feels unsafe or unwise in a given situation, or because of who you are and how that might bias a provider, for example, you are a Woman of Color and you are advocating for yourself or your child in a setting that could, say, get social services involved, stay cool, don’t jeapordize yourself, and call in other advocates and witnesses, even if on a cell-phone. There’s power and safety in this.
Believe in your body, too. If you think something is up with your health, speak up about your symptoms. If you are experiencing subjective symptoms—things like pain and fatigue that others can’t see and measure—try to make them as concrete as possible for the provider by describing how they are impacting your ability to function in your daily life, keeping a journal or log of when symptoms occur, and be as specific as possible about how this impacting your life. If your doctor is suggesting your symptoms are normal, emphasize that you know your own body and they are not normal for you. Describe when they began and, if applicable, how they are changing or getting worse over time.
Make specific concerns the focus of a medical visit by scheduling an appointment just to discuss those concerns with your provider. The average primary care exam is only 18 minutes long. So don't try to squeeze your concerns into an appointment when you're having a full physical or a Pap smear or anything else. When you call the office to make an appointment, let them know you need a full appointment time – that's usually 40 minutes or 50 minutes depending on the practice – not just a 15- or 25-minute quick visit.
Go to medical encounters prepared to describe your main concerns clearly and concisely. Studies have found that doctors tend to interrupt patients after roughly 20 seconds. Before you go in, think through what your main symptoms are, what you'd like help with, what tests or evaluations you’re asking for and why. Write down your key points, and use this as a script when you go in for your appointment. This will help you to keep focused and calm, as well as make you look prepared and organized.
Manage the room by letting your health care provider know, at the start of the encounter, that you believe he or she has your best interests in mind, too, and that respect his or her training, credentials, and knowledge. Managing egos should not be your job, but it can help. Then also let him or her know that you’re learning to become the CEO of your own health and more of an active partner in your own health – you really welcome their partnership and advice. Clearly state that you’d love to havea doctor that sees you this way and who also enjoys working collaboratively.
Bring a friend or relative with you to your appointments. Your advocate can take notes, help you stay on track with your script, and be there for moral support if needed. They can also corroborate your reports of your symptoms. Many women report having a male advocate can be especially useful in getting providers to take their symptoms seriously (how sad is that?). On the other hand, I've also seen situations where a woman brings her boyfriend and the doctor is male, and the boyfriend and the doctor side with each other. So be sure to have somebody you can really trust.
If you feel pressured to accept treatments or recommendations that you believe are insufficient or inadequate for your condition, or you are refused tests for your symptoms without an explanation that you feel confident in, seek a second opinion so that you do receive an accurate diagnosis in a timely way. You shouldn’t have to live with uncertainty when answers often are available. Even when an answer isn’t immediately available, you should feel seen, heard, believed, and supported on your quest.
If your provider is consistently not listening to you, find another doctor. You deserve to be respected. If your health care provider is insensitive, condescending, won't listen, makes you feel small, invisible, unheard, insecure, or if you have to fight to get what you need, that's not good medicine.
For more tips on speaking up and communicating with your doctors, check out my podcasts “How to Talk to Your Doctor and Get the Health Care You Need” and “How to Protect Yourself Against Medical Gender Bias.”
I also talk more about the insidious ways that gender bias affects women’s medical care, in my podcast “Eight Medical Myths Keeping Women from Getting Proper Diagnosis and Treatment” and in my interview with author Maya Dusenbery, Trust Us When We Say We’re Sick, author of Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. I talk more about medical racism, gaslighting, and Black women’s pain in Do You Have a Migraine Personality? with Joanna Kempner, PhD, the author of Not Tonight: Migraine and the Politics of Gender and Health.
The Burden Shouldn’t Be on Women But…
Before we part for today, I want to emphasize something important: The burden shouldn’t be on individual women to overcome medical gaslighting. We need systemic changes within medicine, and pronto.
Here are just a few examples of what needs to shift to end the problem of medical gaslighting, and medical gender bias, racism, fat shaming and more:
- We need to invest more in research on women’s health.Part of the reason women are more likely to be misdiagnosed and gaslight is that medicine just knows less about their bodies and conditions.
- Health care providers need to be given more time with their patients. Over half of doctors report they spend just an average of 16 minutes or less with each patient, while nearly three quarters spend more than 10 hours a week on paperwork. Research shows that when doctors are overworked and time-crunched, they are more likely to make biased decisions and errors.
- We need more training in medical schools on unconscious biases so that doctors are aware of the ways sexism, as well as racism, classism, fat-phobia, homophobia, transphobia can impact the way they treat patients. And they really, really do.
In the meanwhile, and always, it's vital to remember that you are your own best advocate when it comes to your health. Trust your instincts and seek a second opinion if you suspect medical gaslighting. Every individual's health journey is unique, and your voice matters. By being aware of these signs, you can navigate the healthcare system with greater confidence, ensuring that your concerns are taken seriously and your health is prioritized. Respect. Listening. Care. They are basic rights, and we should all, collectively and individually, expect and demand them for ourselves and for those in our care.