I was alarmed by a recent article about patients who feel like their doctors ignore or dismiss their symptoms or problems. Not only would this be frustrating—even infuriating—in some cases the patients come away wondering if they’re crazy. If so, it’s called medical gaslighting, a term that traced to a dark 1938 stage play (and later film) about a husband plotting to drive his wife crazy.

In relationships, gaslighting refers to an abusive emotional manipulation intended to make a person question his/her reality. When it comes to a doctor-patient relationship, I sincerely believe a physician dedicated to helping patients would never intentionally inflict such psychological harm. So, how did the concept of medical gaslighting begin? It comes from a growing number of reports by patients who feel discounted or disbelieved by their doctors.

According to Durbhakula & Fortin (2023), “The reality that patients feel psychologically manipulated by their physicians is deeply concerning and requires equally deep inquiry which, to date, has not been done.”^[i] The authors are responding to a July 29, 2022 New York Times article entitled “Feeling Dismissed? How to Spot ‘Medical Gaslighting’ and What to Do About It.” They write:

The article correctly acknowledged areas for improvement, such as the tendency of physicians to interrupt patients. However, it added a concerning new dimension to the term by asserting that a sign of gaslighting is when “your provider will not order key imaging or lab work to rule out or confirm a diagnosis.” Patients—particularly women and people of color—feeling that their concerns are minimized is a serious concern for the medical profession, but not ordering potentially unindicated tests in response to patient requests is another thing entirely.

They go on to describe a significant shift in the delivery of medical care, and that most of us are already aware of it. The pendulum is swinging away from doctors over-prescribing tests that beget yet more tests—possibly generating needless healthcare expenses—toward value-based care in which the patient receives the correct treatment he/she needs, and no more. This recent trend assumes a process of shared decision making. In turn, this assumes that the doctor utilizes communication skills such as active listening, and clear explanations that avoid obscure clinical words (many of which are in Latin). Key physician skills that have been shown to build patient trust and understanding include:

• The patient and doctor together set discussion agenda
• Patients describe their symptoms without the doctor interrupting them
• The doctor draws out the emotional context the patient is going through
• The doctor responds empathically.

There is good reason why the absence of good health in body, mind and spirit is called disease. Look closely at that word: DIS-EASE. It is literally saying that the patient is no longer at ease in his or her body.

This is often due to a complicated matrix of past and present factors. Durbhakula & Fortin cite a concept proposes by Dr. George Engel in 1977 called a biopsychosocial model of disease. Since then, say the authors, more research supports the idea that “…biological disease is influenced by complex mind-body linkages as well as social determinants of health.”

The vision that doctors would have the training and time to devote empathic listening and conversation seems utopian and even naïve in today’s medical business models. Many of my older patients have flashbacks of a childhood general practitioner (GP) who came to their home with the classic black leather doctor’s bag. They nostalgically recall that the good doctor seemed to have all the time in the world for the beside visit, gently feel their forehead, and reassure the parent anxiously hovering nearby. Durbhakula & Fortin instead describe today’s dilemma imposed by “…factors beyond physicians’ immediate control”:

The proportion of physician time spent on direct patient care has been eroded by escalating administrative and insurance burdens, documentation requirements, and economic models that reward productivity over value. Time-constraints reduce physician and patient confidence in healthcare decision-making, quality, and safety. … Additionally, patients receiving care from time-stressed practices were more likely to report lower levels of support. Such feelings of low support likely fuel gaslighting perceptions.

At the Sperling Prostate Center, we know that prostate cancer patients, or those at risk of prostate cancer, face an underlying life threat. In our practice, there is no excuse for overlooking or ignoring any concern, no matter how minor it may appear. I and my team members strive to fulfill our own ideals. It is our shared expectation that we take the whole person into account as we listen, explain, recommend, and deliver care tailored to each patient’s physical needs and overall quality of life for him and his loved ones. We are confident that our advanced detection, diagnosis and treatment technologies are so thorough and precise that we rarely have to send patients out for added tests that impose more time burdens and healthcare costs. I believe none of our patients ever felt gaslighted, and none ever will.

As Durbhakula & Fortin sum it all up, “Gaslighting means deception. Ensuring that physicians have the time and skill to help each patient feel heard, understood, and cared-for will stop this cynical term from being further linked to the practice of medicine.”

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Durbhakula S, Fortin AH 6th. Turning Down the Flame on Medical Gaslighting. J Gen Intern Med. 2023 Jul 5.