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Keeping Your Patients from Feeling “Gaslit”
By Thomas J. Bryant, ARM
President, Physicians Insurance
June 21, 2022
Effective June 1, 2022, physicians in Massachusetts applying for or renewing licensure must complete two hours of CME on the topic of implicit bias in health care. In a previous blog, I discussed how implicit bias can lead to medical errors, and I shared strategies for your practice.
Another phenomenon linked to implicit bias, which has been the subject of news stories in recent months, is “medical gaslighting.” The term gaslighting has been used increasingly over the past decade, often referring to manipulation in personal relationships where one person denies or minimizes the other’s experiences. Medical gaslighting is a term being used by patients to describe having their medical complaints or symptoms ignored, minimized, or dismissed by their health care providers.
For example, in a March 2022 New York Times article on the subject, one woman in her 30s described her physician minimizing her concerns about chest pains during exercise, which ultimately required open-heart surgery. Another woman had hip dysplasia that had been ascribed as postpartum depression by one physician and attributed to excess weight by another before the accurate diagnosis was made. Social media abounds with similar stories, often experienced by women and people of color.
Supported by Evidence
These perceptions are not “just in their heads.” Studies have shown that male and female health care providers are more likely to perceive women as exaggerating pain and more likely to recommend pain medicine to men, while referring women with pain to psychological treatment.
Black patients were more than twice as likely to have negative descriptors — such as noncompliant, difficult, or resistant — in their physical history or notes.
These biases — usually unconscious — can not only result in diagnostic errors and delayed treatment, but also can lead to poor communication and the erosion of the patient-physician relationship, factors that increase the risk for a malpractice lawsuit.
Patients who feel ignored or dismissed by their physician are more likely to take legal action in the event of an adverse outcome. Whereas patients that perceive communication with their physician as positive view their physician as more competent and are less likely to plan to file a malpractice claim in the event of an adverse outcome.
It’s not the occasional patient who feels ignored or dismissed. In a 2019 Today survey, 38% of women aged 18–34 with chronic pain or a chronic condition said their health care provider dismissed or ignored their symptoms. And 52% of women and 36% of men considered gender discrimination toward patients to be a serious problem.
Biases and stereotypes are deeply rooted in society and in medicine. Medical research and the resultant body of medical knowledge were focused for many years on men’s health; only since 1993 has there been law to ensure the inclusion of women in clinical research funded by the National Institutes of Health.
Medical schools are now taking steps to address biases in medical training; medical curricula, textbooks, and exams even in the last decade still contained race-related biases and misinformation.
Strategies to Improve the Patient Experience
Improved patient communication strategies can help to reduce the influence of implicit bias in your patient encounters — and the reputational and legal risk that can result from it.
- First, recognize beliefs you have that may be based on gender, race, religion, health condition, disability, weight, mental health issues, sexual orientation, or insurance status and that may influence your interaction with your patient.
- Also recognize the likelihood that your patients may have previously encountered bias in the health care setting, which can affect their communication and trust with you. Empower your patients to collect and communicate information about their symptoms in a way that might help get to the root of the problem.
- Ask open-ended questions to elicit more complete information about their concerns and practice communication strategies to build rapport and convey you take their concerns seriously.
- Be aware of and avoid negative or stigmatizing terminology.
- Take advantage of training and education for yourself and your team to recognize potential problem areas related to bias and disparities.
- And as outlined in a previous blog post, implement systems in your practice, such as improving teamwork, using clinical decision support systems, checklists, guidelines, and debiasing techniques.
Implementing strategies to minimize the influence unconscious biases have can help build effective and trustful relationships with patients for improved patient care and a more satisfying experience for both patients and health care providers.
Further Reading
- The New England Journal of Medicine’s collection of articles on Race and Medicine
- National Institutes for Health Office on Women’s Health’s research and education on women’s health
- Massachusetts Board of Regulation in Medicine’s regulation and CME on implicit bias in health care
- Coverys Risk Management article on Best Practices for Promoting Diversity, Equity & Inclusion in Healthcare
