Is your doctor gaslighting you?

The term "gaslighting" originates from a 1938 play and later movie which depicted a husband who manipulates his wife by dimming their gaslights and then denying that the lights have changed, making her doubt her own perception and sanity. The term has since become a psychological term for a form of emotional abuse where one person manipulates another into questioning their own reality.

In the patient safety movement, we hear the term used over and over by patients who feel their concerns are not being taken seriously by their doctors.

Many diagnoses are easy to make and verify, and that satisfies both the patient, who has an explanation for their symptoms, and the doctor, who can suggest treatment and move on to the next patient. If you have visible bleeding or an abnormal ECG or blood test, the disease can be quickly diagnosed.

Many diseases are not that easy to diagnose. The symptoms may be vague and common to many illnesses, and there may be no reliable tests to confirm or refute the diagnosis. This is particularly true for auto-immune disorders. Many such diseases are commoner in women than men, and women are much more likely to report that their doctor tried to say the symptoms were “all in their head.”

Commonly dismissed conditions include post-traumatic stress disorder (PTSD), long Covid and fibromyalgia.

A classic disease that can present in a wide variety of ways and which has no reliable blood or imaging test is endometriosis. Cells that normally line the uterus implant anywhere in the abdomen and cause recurrent pain. It has been found that it takes an average of 8.5 years between a woman first describing her symptoms and a diagnosis being made.

The way out of this dilemma is for both doctors and patients to become comfortable with uncertainty.

The worst thing a doctor can say when confronted with symptoms that have no obvious explanation is “It is all in your head. You are anxious.”

What the doctor should say is “I have no immediate explanation for your symptoms, but I believe what you are telling me, and we will work together to find out what is going on.”

This process may simply require some time to pass. A diagnosis often becomes more obvious over time. Many painful conditions are self-limited and will resolve over weeks.

Diagnosis may require a second (or third) opinion. It may require more detailed imaging or invasive testing that are not appropriate at first presentation, but which are justified as the symptoms evolve.

If you have a doctor who will work with you in this way, hold on to them.

If your doctor “gaslights” you, find another doctor!


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