By Jennifer Kilkus
“I just knew something was wrong.”
“My doctor told me it is normal to have pain as you get older.”
“I went to five different doctors before I was finally diagnosed.”
“I was told there is no way I could have cancer, I’m too young.”
We put a lot of trust in the medical profession. We are usually going to the doctor at our most vulnerable — when we don’t feel well, something is wrong, and we need help. It can be a frightening experience that can become a frustrating or even dangerous one when medical concerns are minimized or dismissed.
A recent CNBC article labels this phenomenon “medical gaslighting.” “Gaslighting” is the term used to describe a type of manipulation that is designed to make another person doubt their own judgment or question their reality. “Medical gaslighting” describes the experience of having a medical concern dismissed or arbitrarily attributed to a psychological or neutral cause by a healthcare provider.
Women and people of color are significantly more likely to experience medical gaslighting. There is an overwhelming body of evidence that patients in these groups are more likely to experience delays in diagnoses and treatment and have poorer medical outcomes. There have been some studies, such as this one, that have suggested that women are more likely to be misdiagnosed with a psychiatric condition when they are experiencing symptoms of another medical condition — in the case of this study, common symptoms of heart disease*.
This is the result of numerous contributing factors, including that research on diseases impacting men are more heavily funded than research on diseases that impact women. However, such contributing factors reflect a more systemic and overarching explanation: Medical decision making is influenced by implicit biases held by healthcare providers.
In a previous blog post, I described the use of heuristics in decision making. Heuristics are a mental shortcut we all use to help us make efficient decisions. Unfortunately, heuristics are prone to cognitive biases, errors in judgment that lead us to draw inaccurate conclusions. When we are busy and stressed, we are more likely to make biased decisions based on these mental shortcuts.
Healthcare workers are experiencing greater and greater demands on their time, increasing the cognitive load present when making decisions. Under these conditions, it is more likely that decisions are made based on implicit bias about the patient being seen.
A study that examined cognitive load and physician decisions to prescribe opioids to patients with pain demonstrates this effect. This study found that physicians experiencing a higher cognitive demand were much less likely to prescribe pain medication to Black patients compared to White patients. This may be reflective of an inaccurate belief that Black patients have a higher pain threshold. This inaccurate and biased belief is alive and well: A 2016 study found that half of medical students surveyed believed Black patients have a higher pain threshold than White patients, and this belief changed the treatment recommendations made by the participants.
It is evident that there is an urgent need for change in many aspects of the healthcare system, including education on cognitive biases and how to combat them. Providers also need adequate time to consider all elements of a case before making treatment decisions, but are experiencing a greater burden of administrative tasks such as documentation instead of being able to use their time for patient care. These types of changes are likely to take a significant amount of time. Until there is a wide scale change to reduce medical gaslighting, here some ideas for addressing it if you encounter it yourself.
Documentation is your friend
It can be extraordinarily helpful to keep track of your symptoms so that you have data to provide to your doctor. How often, how intense, and how long you have had your symptoms are all good metrics to log, as well as what you have tried for the symptoms and whether anything seems to help or make your symptoms worse. It may be harder for a physician to dismiss symptoms with data on your side.
It can also be useful to take notes during a doctor’s appointment so you can follow up later with any questions you have or anything you forgot to mention. The time can go by so quickly and it can be easy to forget important things, particularly if you are scared, in pain, or aren’t feeling heard.
It is also important to make sure your medical record accurately reflects the visit. If a physician dismisses a concern, you can request that they document their decision in your medical record.
Two heads are better than one.
If it is at all possible, bring a family member or friend to important appointments. They may hear something you don’t, or they may ask a question you may not have thought of. They can also chime in if a doctor attributes your symptoms something that you know it is not related to, such as stress or your weight. They can act as an advocate for your symptoms being taken seriously. If they can’t physically come to the visit, you can ask if they can call in to listen in during the appointment.
Get a second opinion.
It is OK to get a second (or third) opinion or to change your doctor if necessary. Trust is a fundamental component of any working relationship, particularly one as important as the physician-patient relationship. Continue to seek out a physician who takes your concerns seriously and is willing to help you find answers.
Listen to your gut.
Physicians are the experts in medicine, but you are the expert on you. It can be a relief to hear “Don’t worry, you are fine!,” but if you feel uneasy about letting something go, that may be a sign to seek out a specialist or another opinion.
Jennifer Kilkus, Ph.D., ABPP, is a board-certified clinical health psychologist. She is an Assistant Professor in the Department of Psychiatry at Yale School of Medicine and a member of the Medical Staff at Yale New Haven Hospital.