What Is Medical Gaslighting? Medical gaslighting is an extremely real, harmful, and ugly reality of the medical system both within the U.S. and abroad. Essentially, it refers to the way women are systemically misdiagnosed, under-researched, and dismissed by researchers, physicians, and medical staff when they raise health concerns. Clearly, this is unacceptable and should not be normalized. However, since this phenomenon is well-documented and unquestionably an unfair reality that women (particularly women of color) must face, it is worth understanding and exploring. In this article, we’ll dive into the roots of medical gaslighting (spoiler: it begins with sexism and racism), as well as the essential signs to watch out for so you can recognize medical gaslighting if and when it happens to you. From there we will dive into tangible ways you can simultaneously advocate for yourself and protect your mental health while navigating the healthcare system. Let’s dive in. Defining medical gaslighting How to recognize it when it happens to youNeglecting ‘gender research’ 5 ways to advocate for yourself3 tips to protect your mental health Defining medical gaslighting Medical gaslighting is tricky because sometimes we may not recognize we have been gaslit until after it has happened to us. Interestingly, though the term is usually used to refer to dismissal patients experienced by their physicians, it can also refer to the experiences female physicians report in the presence of their male colleagues. That being said, let’s focus on the medical gaslighting that most often occurs between female patients and the medical staff, administrators, and physicians they encounter when they investigate a health issue. Typically, medical gaslighting involves: A dismissal of women’s health problems, often accompanied by misogynistic undertones Most notably, women’s physical symptoms are written off as a result of their emotional and psychological ‘volatility;’ in particular, women’s physical pain is often dismissed as ‘hysterical;’ their physical symptoms explained away as ‘imagined’ or ‘exaggerated,’ and so on. A private exchange that leaves you feeling uneasy One female physician explains, “gaslighting can be differentiated from other forms of bullying in medicine because it does not involve public humiliation, specific threats, or blatant insults… gaslighting is more subtle than that.” Often medical gaslighting is private, and almost ‘invisible.’ For instance, you may leave an exchange feeling unheard, uncomfortable, dismissed, or uneasy. You may find yourself asking questions like, “did I not communicate the severity of that symptom?” or “I have a feeling I should still investigate this, but maybe I’m being overdramatic?” If you suspect that you are being medically gaslit, then you should absolutely seek a second opinion. Your physical, emotional, and psychological health warrants the highest care, no question. A general lack of empathy, or a minimization of your concerns If you approach your doctor with a problem, they should first ask you follow up questions regarding your symptoms, and ultimately explain why or why not they believe this problem warrants further investigation. If they simply hear your problem, and immediately dismiss it without inquiring further, explaining their decision for doing so, or showing any empathy or understanding, then that could be medical gaslighting. At the end of any appointment with a healthcare provider, you should leave feeling understood, heard, and that you have been given the information you need to understand what is happening with your body. You might even question if you did a good enough job in the appointment, or that you feel that way because of your own fault. Know that it is your provider’s job to dig in and listen to your concerns, not you pestering them into understanding. We shouldn’t settle for any standard lower than this. Recognizing medical gaslighting Feel free to use the following check-list to help inform you as to whether you may have experienced medical gaslighting or not. Please note that this isn’t exhaustive, and if you feel deeply unheard or dismissed by your doctor, but the reason for it isn’t necessarily on this list, then you should still seek a second opinion if you feel compelled to do so. Several of the following may indicate medical gaslighting: You are told you’re just ‘tired’, ‘stressed,’ or ‘overthinking it’ If this is accompanied by little investigation or care, then this is a red flag. Sometimes non-specific symptoms (like fatigue, headaches, and so on) can be the cause of one of the above, but sometimes they can be indicative of autoimmune diseases or something more serious. A general blood panel can confirm anemia, and popular vitamin tests (think checking vitamins D and B-12) can confirm common deficiencies that may provide an explanation for ‘general’ symptoms like fatigue.Moms are served an even bigger dose of this, often being told: “of course you’re tired, you’re a mom.” Though, would a provider be saying the same to a male partner? Probably not – they would likely find a treatment that works to resolve their symptoms. You are laughed at or poked fun atDerisive behavior such as the above is absolutely not okay, and should never be acceptable. Your doctor tells you it’s in your head, or the result of hormones, with little investigation Again, sometimes physical symptoms can manifest from a hormonal imbalance (hello, PCOS) or anxiety, but equally: troubling symptoms deserve objective investigation. For instance, women are more often misdiagnosed than men, and in particular, some doctors only look for the male signs of an illness (a good example is heart disease, which can manifest itself differently in women than in men) – pay attention to whether your doctor is interested in understanding the ‘why’ behind your symptoms. You feel like they don’t truly see you If your physician displays little empathy or views you as just another patient to cross off the list, this is troubling and potentially indicative that they may fall back on unconscious biases that prevent them from properly investigating what is going wrong. Your symptoms are trivialized, even as they get worse If things keep getting worse, but your doctor finds new reasons to minimize them, without interest in identifying the root cause – this is troubling behavior and should definitely be viewed as concerning.Your weight is blamed as the cause of your symptomsThis applies to people one both ends of the spectrum: those in larger or smaller bodies. If the response is “just lose weight” or “just gain weight,” run. This cannot be emphasized enough: weight gain did not cause your PCOS, and weight loss will not cure it. Yes, lifestyle choices and weight are often associated, however, they do not always have a causal relationship. Furthermore, if it is unrealistic for you to adopt the suggested lifestyle changes, you deserve to know and be offered appropriate pharmaceutical or medical treatment options without judgment.If you are given blanket advice to eat less and move more: red flag. If time isn’t being taken to understand your lifestyle, stressors, home dynamics, sleep, nutrition and exercise habits; red flag. If you aren’t being referred out to work with a registered dietitian nutritionist to address ongoing nutrition counseling, yet you were given diet advice; red flag. Unfortunately, medical gaslighting can happen in a number of contexts, including outside the doctor’s offices: one study in the Journal of Emergency Medicine found female patients with the exact same symptoms as male patients had to wait an average 33% longer to receive help. Neglecting ‘gender research’ Besides unconscious bias, which definitely plays a part in misdiagnosing women (especially women of color), the fact that research into many health conditions is fundamentally androcentric is unhelpful to say the least. By that, we mean that most funding, research, and clinical studies have historically completely ignored women (and only focused on male subjects), or have invested only a minority of resources into understanding how medications, diseases, and disorders manifest in and affect women differently. Before the 1990’s it was common practice to exclude women from research intentionally, as it was thought their cycling hormones and ‘delicate constitutions’ should not be subjected to the rigors of research participation. Then, clear gaps in medical understanding were recognized, and it was clear that their inclusion was necessary.. Enter ‘gender research.’ The National Institute of Health introduced new guidelines in 1993 under the Revitalization Act that requires NIH-funded clinical trials to include women and racial minorities as participants and assess outcomes by sex, race, and ethinicity. Unfortunately, by the NIH’s own findings, in the study sample they reviewed, this policy yielded “no statistically significant changes in inclusion, analysis, or reporting by sex, race, or ethnicity compared with the previous studies.” Perhaps even worse, the Journal of Women’s Health found that a significant number of federally-funded trials weren’t even in compliance with the NIH’s aforementioned policy. So why are researchers still reluctant to include women in clinical studies? Why do men get most of the research and funding? Well, simply put, women’s inclusion can ‘complicate findings.’ One physician explains, “men and women are different in the way they metabolize or process drugs . . . in women the pharmacokinetics can be affected by higher body fat composition, lower body weight, slower GI, less intestinal enzymatic activity, and slower kidney function.” Of course, if the assumption has historically been that women metabolize drugs in a similar fashion to men, then findings to the contrary do make the research more complicated. This is then compounded by the fact that the impact a drug has on the body is further affected by “many factors, including sex hormones . . . responsible for menstruation, pregnancy, menopause” (not to mention oral contraceptives). In short, since it is cheaper and easier to study men (one study suggests it could quadruple costs to replicate the ‘gold standard’ of research on women), that is what the pharmaceutical industry and the healthcare system has focused on. If you’re like us, then you also may find it hard to believe that the research hyper-focused on a portion of the population (White men), can be then generalized and applied to everyone else (BIPOC women and men, White women, trans and intersex individuals, and so on). Undoubtedly, this willful denial of other biologies and experiences plays a part in doctors not being able to fully know how certain symptoms, medications, and diseases can manifest in anyone other than the researched subject. 5 ways to advocate for yourself Medical gaslighting, as we mentioned before, is a sad reality of the healthcare system. But there are plenty of physicians, researchers, and staff out there who are working hard to change the status quo, including women themselves who are “willing to be part of the [clinical] process and can contribute to our understanding of drugs.” In the meantime, here are some steps you can take to advocate for yourself: Go to your appointment with a loved one When you’re facing physical illness, it can be an overwhelming and distressing experience, which is only compounded by fears of gaslighting. Bring someone with you to your appointment, preferably someone who is aware of your symptoms and can act as not only moral support, but if necessary a supporting voice if your doctor communicates disbelief or tries to minimize your concerns. This can also be helpful as, if you are not sure if you have been medically gaslit after an experience, the person accompanying you can share their viewpoint on this as well. Find a different healthcare provider (if possible) If you feel that you’re experiencing medical gaslighting, we highly recommend you search for a different physician. Look at their reviews online, paying particular attention to what other people have to say about their empathy levels, and how much of a true interest they take in their patients. If you would be more comfortable, search for a physician who identifies as BIPOC or female. Keep in mind that just because a physician identifies as a minority or woman does not mean that they will automatically be the most sensitive to your concerns: whether male or female, ideally you are looking for a healthcare provider who is empathetic, open-minded, and has a track record of taking their patients concerns seriously and respectfully. Plan out what you would like to discuss ahead of time Sometimes it can be difficult to remember the intricacies of events that happened a few days ago, nevermind weeks or even months. In advance of your meeting with your physician, write down (preferably with the date and time noted) of your symptoms. How do you feel? What were you doing before this symptom flared up? Is there something that seems to trigger it? Over time you can review your notebook entries and begin to identify patterns. This is also useful as, if your physician does express distrust or disbelief, you have your own record of events that you can refer to and show the next doctor you consult. If you feel that weight status may also come up, mentally prepare for that. With an annual-type visit in mind, prepare a list with the health ‘wins’ or positive changes you’ve experienced in the past year. You might also prepare a second list with goals or areas for growth in the coming year. You may also ask not to be weighed, as long as not medically necessary. Another option is to ask until your appointment is complete to get your weight measured, or ask explicitly for the number not to be shared with you. All are options to limit weight bias or ‘fatphobia.’ Push back when necessary As women, we are often conditioned to not appear ‘difficult,’ ‘dramatic,’ or ‘bossy,’ but the fact is, men don’t have these same reservations. Often, they have no concern about pushing back on a thought or idea they don’t agree with (on the contrary, they are rewarded for being ‘assertive’). Although it goes against decades of social conditioning, what is of utmost importance is to prioritize your physical health. No one else knows what it’s like to live in your body every day, no one knows your symptoms quite like you do, and no one can tell you how small or big your pain is. Even if you worry that your doctor may not like you for expressing disagreement, this is secondary to your emotional and physical wellbeing. You deserve to have all your questions answered. You deserve to be listened to. And you deserve to have your symptoms investigated in a serious manner, so you can truly understand what is going on with your body. A good litmus test for whether pushing back is appropriate or not, is to ask yourself: if a man expressed this sentiment in a respectful, calm manner, would he be viewed as rude or noncompliant? If the answer is no, then chances are your reservations are rooted in gender expectations, and you should communicate (as objectively and calmly as possible) your concerns. Trust your gut For instance, if you are told that a lump is a cyst, but you feel deep down that something isn’t quite right, ask for your doctor to refer you to a specialist just in case. If they still refuse, you can seek out a second opinion. Of key importance here is listening to what your body is telling you: if this symptom feels especially serious or out of the ordinary, or you just have a bad feeling that this isn’t an insignificant problem: honor your feelings and investigate the problem until you feel you have the answers you need. Sometimes this can feel extremely time-consuming and tedious: searching for different providers, ordering at-home tests, and so on, is not ideal, but it is important to do what is in your control to achieve peace of mind. Check out this article for more advice for how to advocate for yourself in the healthcare system, particularly if you have (or suspect you have) PCOS. In closing, if you have been medically gaslit: know that you are not alone, and that it’s not okay. Everyone deserves access to quality healthcare, yourself included. By no means are all doctors making snap judgements, but it can happen, so have faith in your own account of events, listen to your body, and don’t be afraid to seek out a second opinion. Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.