(Originally published in Doximity Op-Meds, a platform for physicians, on March 16, 2023 as ‘The Measure of a ‘Good’ Physician Should Not Be Someone Who Does Everything a Patient Asks Them To Do’. Published here in its original form with a selected Bibliography/further reading at the end.)
Two recent New York Times articles highlighted the term “medical gaslighting,” a phrase that has been popularized on Instagram and social media by people who felt that their symptoms were ignored or dismissed. The term medical gaslighting will likely do more harm than good. A lot of people already have a general distrust of medical providers, especially post-pandemic, and introducing ‘gaslighting’ will add to the lack of confidence in our healthcare system. While the medical community knows that women, LGBTQ, POC, and geriatric populations are more likely to have suboptimal care or delays in diagnoses, call medical gaslighting for what it is: a lack of knowledge or expertise on the physician’s part, a medical oversight, and, more importantly, systemic racism or unconscious bias. But don’t call it medical gaslighting. Health care providers are now going to have an influx of patients and their families coming to tell us that they feel they are subject to medical gaslighting. For one, I already think that the term “gaslighting” is being overused, and inappropriately used. Gaslighting, in its original definition, based on the 1944 film with Ingrid Bergman, Gaslight, is making another person feel like they’re crazy and what they’re experiencing isn’t real. That is not the intention of most medical providers.
Let me be clear:
But let me also be clear: Gaslighting is not simply a difference in opinion. And medical gaslighting, if we are to use this new and likely damaging term now, is not the difference between an educated, medical opinion and the patient’s opinion. It’s not gaslighting when medical professionals are just doing their jobs.
For a major news outlet to print something like this, in a time where the majority of health care workers already feel burnt out because they (we) have been taking care of patients through a pandemic for two and a half years, is highly detrimental. In fact, it’s a wonder why all physicians don’t just walk out now and leave patients to their own devices (pun intended), if they can just google their own symptoms, make their own diagnoses, and order their own tests and treatments online. What do you need this middleman for? This skilled middle person who actually trained for over a decade to do exactly those things?
Even in a world where our health care has become mostly consumer based — we are graded by patients for our care, we are graded by our institutions for our productivity, and we are graded by insurance companies for our frugality — there is a reason why health care isn’t just a fast-food chain where you can go in and order anything you want, and fries with that. Medicine is a science, but also an art. Remember, you call it “getting a second opinion,” not “getting a second ‘fact.’” Sometimes there is black and white, but I would say a lot of times there isn’t. And physicians live in this gray area, where we have to make the best decisions we can based on what information we have. And the patients have to trust that we are making the decision in their best interest.
That brings up three points. One: We make evidence-based decisions for our patients. There is so much research out there resulting in hundreds of articles with new information daily. Some of it affects clinical practice, some of it doesn’t. But physicians are sitting in this mire of information daily, and using it to make evidence-based decisions. As much as one can educate themselves, I do not think you can reach the level of specialty or subspecialty knowledge with just Google. For example, I am a colorectal surgeon, and my recent encounters with reproductive medicine left me in awe at just how much one subspecialized field might not know about another subspecialized field. I do not claim to know the grading of embryos, or the intricacies of theoretical physics just because I read a Neil DeGrasse Tyson book. Why do patients think they would know medicine because they read WebMD? I want patients to do their own research and take part in their own care, but not to the point of excluding our trained assessment.
Two: Patients trust that physicians are making decisions in their best interest. The key word here is trust, of course. I don’t blame people for the breakdown of trust in our country — we don’t trust the government, we don’t trust large institutions or systems which seem only to be out to screw us. Again, in my own experience, even as a physician, navigating the health care system for myself has proven difficult. But aside from lack of trust in the health care system, individual physicians are rarely out to hurt people. Just think of all the bright-eyed medical students entering medical school because they want to help people and save lives. The lack of trust in health care should not extend to every individual physician. Most of us really are here to help in any way we can, when not being handcuffed by insurance and bureaucracy.
Three: Sometimes, when a patient is sitting in your office, it’s hard for them to understand why we don’t do all the tests. Providers know that there is harm in unnecessary testing, leading to more invasive tests, bills, and misdiagnoses while chasing after a symptom. The comments in the NYT post were interesting — most people agreed that they had been medically gaslit. There were several comments like, “All doctors are like this,” or “Aren’t they trained to be this way?” Well, perhaps if we are all like this, then maybe we are all trained to be this way — that is, not ordering unnecessary tests that can cause more harm than good, just because someone asked for it, or not doing a certain procedure because it can do more harm than good. Again, we were trained to make these decisions, right? I will acknowledge that patients know their own bodies (Some of them do, anyway; there are always the ones who have no idea what’s going on in their bodies.) and should advocate for themselves. But the measure of a “good” physician should not be someone who does everything a patient asks them to do. A “good” physician should be someone who listens, thoroughly understands the patient’s complaints, and then makes the best decision they can for and with that patient. Sometimes it means further testing and treatment, sometimes it does not. And if you don’t like it, like some of the commenters said, I guess you can “shop around” for a physician who will do what you want. Just know, buyer beware.
The next time the phrase medical gaslighting comes up, both the physician and the patient should take a step back and consider: What is the intent here? Is the intent to make the patient feel discredited? Or is the intent to have a medical opinion that is different from their own? There are ways to make a patient feel heard while explaining your rationale for doing things.
*Why shouldn’t a physician consider their own livelihood? It used to be an honor and a privilege to be a physician, and now we are considered second-rate public servants, subservient to the needs of a disgruntled population. Again, look at the burnout rates. There is a lack of empathy for health care workers, just like for all service-oriented professions. Did you forget that physicians are human, too? We have lives, families, and hobbies. Trying to take care of you is just one of the things we do, and we would like to do it without constantly being under attack.
**Systemic gaslighting results in imposter syndrome, when a person feels like it’s their own failings rather than an inequitable distribution of resources. That is also on my mind, but that is a different op-ed.
