How to spot a “medical gaslight” and what to do about it.

Christina, who lives in Portland, said she was neglected by doctors for years. When she gained 50 pounds, her providers sometimes blamed her body size when discussing her health issues.

One incident happened a few weeks after he fell off his bike. “My elbow was still hurting,” said Christina, 39, who asked to remain anonymous while discussing her medical history. “I went to my regular primary care doctor and he just waved his hands and said, ‘You’re overweight and it’s putting stress on your joints.'”

Eventually, Christina went to an urgent care center, where providers ran X-rays and discovered that she had broken a bone in her hand.

The experience of being dismissed by a health care provider, known as medical gaslighting, can happen to anyone. A recent New York Times article on the subject received more than 2,800 comments: Some cited misdiagnoses that nearly cost them their lives or delayed treatment and caused unnecessary suffering. Long-term Covid patients have written about feeling neglected by doctors they seek help from.

Recently, the problem has received attention from both the medical community and the general public, disproportionately affecting women, people of color, geriatric patients, and LGBTQ people. For example, research shows that women are more likely than men to be misdiagnosed with certain conditions, such as heart disease and autoimmune diseases, and they wait longer for a diagnosis. A group of researchers have found that doctors are more likely to use negative descriptors such as “inconsistent” or “disclosed” in the health records of black patients than white patients – which can lead to health care disparities.

“Gas lighting is real; it always is. Patients, and especially women, need to be aware of this,” said Dr. Jennifer H. Mieres, professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and author of Heart Smart for Women.

Here are some tips on how to protect yourself in medical situations.

Gaslight can be subtle and not always easy to spot. When seeking medical attention, experts recommend watching for the following red flags.

  • Your provider won’t let you interrupt and divulge details, and won’t seem like an engaged listener all the time.

  • Your provider will minimize or downplay your symptoms, such as asking if you have pain.

  • Your provider refuses to discuss your symptoms.

  • Your provider will not order basic imaging or lab work to rule out or confirm a diagnosis.

  • You feel that your provider is rude, condescending or insulting.

  • Your symptoms are attributed to a mental illness, but you have not received a mental health referral or been tested for such an illness.

“I always tell my patients that they are the experts on their own bodies,” said Dr. Nicole Mitchell, Director of Diversity, Equity and Inclusion, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine. “We’re going to work together to figure out what’s going on and what we can do about it. It really has to be a shared decision.”

Keep complete records and records. Dr. Mitchell recommends keeping a journal in which you enter as much detail as possible about your symptoms. The tips she offers include: “What are your symptoms? When do you experience these symptoms? Have you noticed any triggers? If you have pain, how does it feel? Does it wax and wane or is it constant? What days do you notice this disease?”

In addition to your notes, write down all your lab results, pictures, medications, and family medical history.

It’s like seeing your accountant at tax time, Dr. “You certainly don’t come without a receipt,” Mieres said.

Ask a question. And ask again. Prepare a list of questions you want to ask before the appointment, and be ready to ask other questions as new information becomes available. If you don’t know where to start, Dr. Mitchell suggests asking your doctor, “If you were me, what questions would you ask right now?”

Bring a support person. Sometimes a trusted friend or relative can help keep you company, especially when discussing a treatment plan or a serious medical issue.

When people are sick, scared, or anxious, it can make it easier to “freeze the brain,” says Dr. Mieres said. “We don’t think, we don’t listen adequately, we don’t process information.”

Talk to your support person to clarify their role and discuss your expectations, she added. Do you want them to take notes and be a second ear? Or do they need emotional support first? Are there times when you want a friend or relative to leave the room to discuss personal matters?

Focus on your most pressing issue. According to a study published in 2021, providers are short on time, and the average primary care exam lasts only 18 minutes. Mieres suggests jotting down points that summarize the reason for your visit so you can communicate effectively with your doctor 10 minutes before your appointment.

Pin the next steps. Ideally, you should leave your appointment feeling relaxed. Tell your provider that you want to understand three things: your best guess at what’s going on; plans to diagnose or rule out any possibility; and treatment options depending on what is found.

Switching providers. A study using data from 2006 and 2007 estimated that about 12 million adults in the United States are misdiagnosed each year, and about half of those errors could be harmful. If you are concerned that your symptoms are being ignored, you have the right to seek a second, third or fourth opinion.

But in many cases it can be easier said than done. Finding another specialist who takes your insurance and is willing to meet right away isn’t always quick or easy. If possible, try to get a network referral from your current doctor. For example, you could say, “Thank you for your time, but I would like another opinion on this. Could you refer me to another specialist in your area?”

If you feel uncomfortable asking your doctor for a referral, you can also speak to your patient liaison or nurse manager. Alternatively, you can ask friends and family, or call your insurance company to find someone in the network.

Reframe the conversation. If you decide to contact your current provider, but that person doesn’t seem to be listening, Dr. Mieres suggested that patients try to redirect the conversation: “Let’s hit pause here, because we have a disconnect. You are not listening to me. Let me start again.”

Or: “I have had these symptoms for three months. Can you help me find what is wrong? What can we do to figure this out together?’

Reach out to support groups. There are many condition support groups that can provide helpful resources and information.

Diagnosed in 2017 with granulomatous mastitis, a rare, chronic, inflammatory breast disease, Tami Burdick found help from an online support group for women with the same condition.

Initially, she was referred to an infectious disease specialist, who confirmed the presence of bacteria from a breast biopsy.

“I developed horrible, painful abscesses that would pop open and drain on their own,” says Ms. 44-year-old Burdik said about this.

In search of answers, he did extensive research on the disease. And from a support group, she learned about a gene sequencing test that can identify potential pathogens. Ms. Burdick asked her surgical oncologist for a test, and found that she had contracted a specific microorganism associated with granulomatous mastitis and recurrent breast abscesses. It took up to seven months of investigation, but it was finally answered. To help other women, she and her oncologist published a book about her experience.

“If an infectious disease specialist had looked into this,” he continued, “I probably would have started antibiotics right away, right there, and never needed surgery.”

Appeal to the higher authority. If you are being treated in hospital, you can contact patient protection staff who can help. You can also solve the problem with the doctor’s supervisor.

Finally, if you are dissatisfied with the care you are receiving, Dr. Mitchell says you can report your experience to the Federation of State Medical Boards.

“Any abuse, manipulation, gaslighting, delayed diagnosis are all reportable events that providers need to be aware of,” said Dr. Mitchell said. “Doctors must be held accountable.”

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