The patient needs to know their practitioner is on their side.
How the Medical System Sets Up Practitioners to Fail
I think that having to center a practice around insurance codes to justify labs, imaging and treatments benefits neither patient nor practitioner and it facilitates medical gaslighting. Of course, I do use these codes to justify labs and imaging, but my office also has good relationships with labs and imaging centers to get patients reasonable cash pay prices when insurance refuses to pay for quality patient care. If a patient’s condition can’t fit neatly into an insurance-approved diagnosis, it’s easy to see how tempting it can be for the practitioner to dismiss that patient’s symptoms.
I also think that the short amount of time that most conventional practitioners get to spend with patients promotes medical gaslighting. Got a complicated patient? No time for that! Their symptoms can’t be as bad and/or there can’t be as many symptoms as they are talking about. Sometimes, practitioners just shut down and move on, ignoring patient symptoms or just pretending that certain symptoms don’t exist.
What Can Practitioners Do?
First, both practitioners and patients must recognize that their relationship is a partnership rather than a parent-child type of relationship. The practitioner and the patient are both responsible for clear communication and each is accountable for doing their best in the patient-provider relationship.
With EMR and telemedicine, one of the biggest complaints I hear from patients is that their doctor never looks up from their computer screen during the visit. Obviously, that patient isn’t feeling heard. I think, for the practitioner, brushing up on typing skills and developing the ability to type without looking at the screen would be very beneficial.
It’s also important that practitioners not dismiss a patient’s problems as a consequence of “getting older” or from “hormones.” Of course, we know that age and hormone balance play a big role in health, but women often feel blown off when the doctor says, “Well, it’s just hormones.” That’s medical gaslighting and it’s not good care for the patient. As practitioners, it’s our responsibility to investigate the root cause of our patients’ problems rather than blaming it on an umbrella cause.
As a practitioner, it’s OK to suggest to a patient that they get a second opinion if you aren’t able to figure out what’s going on or if your treatments aren’t effective. Patients appreciate that their practitioner is advocating for them in this way. Being honest with your patient when you’ve reached your limit ensures that they feel heard, even if that means they get care from someone else.
For both patients and practitioners, if there’s a disagreement between the two of you, don’t take it personally. I often see practitioners get defensive when a patient disagrees and/or asks questions about aspects of their care. Reframe that disagreement as an opportunity to ask more questions and clarify what your patient is feeling. It’s a good opportunity to teach patients more about what you think is going on with them. Patients who ask a lot of questions are generally quite willing to take in information and learn.
How a patient’s treatment is framed up matters. Many times, my chronically ill patients tell me that an anti-anxiety or anti-depressant was prescribed for them without explanation. This form of medical gaslighting makes the patient think that you think they are crazy and that their symptoms are all in their head. If you are prescribing these meds, it’s good for the practitioner to take a little extra time to explain to the patient why you are prescribing and how this fits into the long-term treatment plan. The patient needs to know their practitioner is on their side.
Practitioners, call yourself out if you need to. If you’re feeling overwhelmed or overworked, you’re more likely to medically gaslight your patient. We all are. If you’re getting into the headspace where your patients are annoying you, it’s probably time to check yourself and get back into the right headspace where you can offer quality and compassionate care.
What Can Patients Do?
Patient advocacy resources suggest that bringing a person to a patient’s visit can cut down on gaslighting because it often happens when the patient and practitioner are alone. That suggests that accountability from another source cuts down on medical gaslighting, so having another person at your visit can be helpful. There are also services that record patient visits, which may provide a similar accountability to having a person in the room with you.
Conclusion
While this article is practitioner focused, I believe patients can benefit from reading it as well. If we bring medical gaslighting into the open and can identify it, we can recognize it for what it is if it does happen. Recognizing medical gaslighting for what it is can help take away its power, both on the practitioner and the patient sides of the relationship. QCBN
By Amber Belt, ND
Amber Belt, N.D. is a naturopathic physician and co-owner of Aspen Integrative Medical Center where she helps patients get healthy from the inside out. She is also co-owner of Sage Sirona, which focuses on natural first aid and education. Dr. Belt has been practicing naturopathic medicine for more than 15 years and can be contacted via aspenmedcenter.com or sagesirona.com. You can also call her office at 928-213-5828.
