I was scrolling through my phone today looking at the Top Google News Articles when I came across an CNBC article titled, “how to recognize Medical Gaslighting and better advocate for yourself at your next doctor's appointment.” And to be honest, as a medical professional, I got a little irritated at the title. So naturally, I had to click on the article to see what kind of bologna was being disputed about me and my clinical colleagues.
But then I finished the article. And I thought, hmm, I actually agree with what this article had to say – for the most part. What I don’t agree with is the term “gaslight” for the article, but I understand that the author was trying to get a point across. From my point of view and review of the term, gaslighting is an intentional manipulation to have another person doubt themselves. I do not believe that most clinicians are “gaslighting”, but I do believe they can sometimes be dismissive, or somewhat neglectful.
So what can you do as a patient if you are struggling to be heard by your clinician?
If allowable, you may be able to bring a friend or family member to your appointment. This may help reduce your anxiety, and have someone there to help advocate for you if you are struggling to communicate well with the provider you are seeing. It never hurts to bring an extra set of ears as well to make sure you pick up all of the information your clinician is telling you.
Another recommendation which is my personal favorite is to take notes before you come to your appointment. I believe when you take notes, you can organize your thoughts to be able to utilize the time you do have with your clinician to the maximum potential. Some notes I would jot down are the timing, frequency, and severity of your symptoms, when you started to notice symptoms, how often you experience symptoms, and what seems to aggravate or alleviate symptoms. The more specific you can get, the better it helps us to help you.
Another method to prepare for an appointment with your provider is to practice mindfulness prior to coming to your visit — especially if you are nervous or anxious about the meeting. This can be a chant that you tell yourself, or a breathing exercise while you are waiting for the doc to come in.
If you are a provider trying to better yourself to prevent being dismissive, I personally do these things that may help you, too.
If you have a patient you are seeing for “X” problem, and they bring up at the end of the visit “Y” problem, it can be quite difficult to stay on track. I believe this scenario can contribute to some of the burnout we experience as providers. I have found some ways to help combat the burnout but also make sure the patient’s concerns are being addressed.
In my experience, if a patient brings up a new problem to me at the end of our visit, I will typically ask a few questions to get a better understanding of what the problem is, and how long it has been going on. You want to make sure this is a non-urgent complaint. For example, if someone is having new onset knee pain, but it just started after a run they did, then it is considered an overuse injury and non-urgent. However, if someone is saying they have new onset lower extremity numbness with bowel and bladder changes, it will NEED to be addressed. So if the scenario is the former, then I will offer my patient a dedicated revisit to their new problem in the upcoming weeks. I let them know that I hear their concerns, and I want to address it, but that I need to address it appropriately with enough time to go over a thorough history and exam with them. This is typically reciprocated well.
In the meantime, I will coach my patient to look for signs and symptoms until our next visit. So as a continued example of my patient with new onset knee pain, I will ask them to see how long it takes the knee pain to start and to list any aggravating factors or movements in addition to alleviating factors. That way, when they come in for follow up, our history is super laser focused and I can give my full attention to the physical exam, diagnosis and treatment recommendations.
So to reiterate for my patients – some things that help US help YOU are as follows:
Stay focused: if you can focus on one area, concern, or body part, our exam and plan will be just as focused and we will be able to accomplish more. I think of the saying, “How do you eat an elephant? One bite at a time” which means big issues need to be broken down into smaller, more bite sized pieces get get the results we are all looking for.
Have an open dialogue: just remember, we are here as clinicians to help you! If you are not expressing your concerns, then that can cause a kink in the communication chain and may affect our ability to understand and treat you. We know that signs and symptoms affect more than just a body part – there is a psychological component that is often neglected, but needs to be addressed more to provide better overall outcomes.
Be careful to not confuse neglect with a step-wise medical approach. A provider that refuses to order an MRI for your low back pain because you refuse to do PT first is not neglect. We need to be mindful that some basic first line treatments will help, and should not be overlooked. It is when you give your effort to try first line treatment without response that we will move to additional testing, imaging, treatment, etc.
Lastly, I know that every profession has their “bad apples” and medical is no exception. As much as I wish that was not true, it is. If you are struggling with a certain symptom, or have noticed something of concern, and continue to be dismissed, you have the right to ask to see a specialist to evaluate you. If you are currently seeing a specialist and still experiencing this type of treatment, then you need to consider a second opinion.
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