"Medical Gaslighting"?
Can doctors actually gaslight their patients?
I was taken aback by the term used in the article published in JAMA Network Open:
Medical gaslighting has been defined as, “…an act that invalidates a patient’s genuine clinical concern without proper medical evaluation, because of physician ignorance, implicit bias, or medical paternalism.” In medicine, the clinician-patient relationship is certainly vulnerable to gaslighting, in which disbelief in patient report (testimonial injustice) may cause a patient to question their own experience of illness.
The proper terminology is "epistemic injustice," whereby a person's concerns are dismissed by someone else, causing that person to question their own perception of reality, or to make them feel "crazy."
The article was describing the experiences of patients who were referred to a specialized clinic for vulvovaginal disorders. When I read the article and the term "medical gaslighting," I reached out to the primary author, Dr. Chailee Moss, to have her come on my podcast (the link the episode is at the end of this article) to discuss her article and the "medical gaslighting" itself.
The findings of the article were eye-opening: less than half of patients said that past practitioners were supportive; a little more than a quarter were actually belittling, and one fifth were described as not believing the patient. What shocked me was that 20.6% of patients were given a recommendation to drink alcohol to relieve their symptoms. Moreover, 16.8% of patients felt unsafe during a medical encounter and 39.4% said they were made to feel crazy.
The actual narrative responses were also instructive, and they are reproduced here:
The most important takeaway from the article and my conversation was that we must do all that we can to ensure patients feel heard. Even if we can't find something specific to treat, we should do our utmost to ensure that patients' concerns are not perceived as being dismissed. This applies to all specialties, including critical care. Also, "drink more alcohol" should NEVER be a medical recommendation, in my opinion. It was a very important lesson for me, and it is one I will do my best to remember every day of my practice.