Unfortunately, not all medical professionals are familiar with the term "medical ." But, as an academic allergist/immunologist and autoimmune patient, the recent headlines recounting stories of medical gaslighting don't surprise me. Daily, I see patients who report having their symptoms second-guessed, minimized, or outright dismissed.
Even being an immune system expert didn't spare me many of the frustrations and biases common to the workup of an autoimmune condition. Although it was hard to admit, I gaslit myself before my own symptoms of fatigue and dryness were too severe to ignore any longer. A comment from my dental hygienist finally sounded the alarm and moved me to push for and pursue additional testing.
Bright-eyed medical students set out to ease suffering, to serve, and to heal, but within the pressure cooker of medical training and clinical practice, the majority of us will burn out -- emotionally exhausted, increasingly cynical, and defaulting to cognitive biases. Recent of us have symptoms of burnout. As a result, our own health and that of our patients suffers.
The reality is that we are all attempting to function within a very broken system.
Patients navigating a siloed, complex, inefficient, and expensive system are increasingly distrustful of the medical establishment. Many patients will stop seeking care "poor physician-patient relationships, feeling rebuffed or treated with disrespect, and being denied care."
Physicians find ourselves practicing under increased pressure from all sides with less time and resources to help sicker patients; answering not only to our patients' needs but those of insurance companies, pharmacy benefit managers, the government, and other interested parties whose motives are usually less than altruistic.
The result of all this? Physician burnout, a fracturing of the physician-patient relationship, and yes, you guessed it, the proliferation of medical gaslighting.
To find a solution, we need to perform a root cause analysis (RCA) -- the systematic process used to determine why a patient has suffered an unintended consequence -- by scrutinizing everything that interferes with the physician-patient relationship. The purpose of the RCA is to systematically prevent and solve for underlying issues rather than just bandaging the wounds.
Outside influences are always easy targets, but we need to get curious about the culture of medicine, too. How are our biases materializing in our words and actions? How are they showing up in our patient care?
We need to mitigate the moral injury (or burnout) that so many of us know far too intimately and address the trauma our healers will inevitably witness over the course of their careers. How do we begin to address the mental health of our healthcare professionals when seeking care can result in ?
Sadly, these are not issues affecting only those of us who have been in practice for many years. A 2015 JAMA systematic review and meta-analysis demonstrated that between of trainees screened positive for depression or depressive symptoms during residency.
From crushing medical student debt pushing students into higher-paying specialties to medical bankruptcy experienced by our patients, we need to seriously consider how medical care is reimbursed and our insurance-based systems are structured. Time spent with patients building a therapeutic relationship is not valued, prevention is not rewarded, and the time it takes for physicians to get curious and think critically about non-textbook situations is not encouraged.
This list goes on. Rather than getting stuck in the overwhelm, we can instead work to get comfortable in the uncomfortable spaces and take back control. No quick or easy solutions exist, but here are three strategies I share with my colleagues and trainees:
- Actively listen and validate the patient's experiences. We can never fully walk in the patient's shoes, but we can listen. More importantly, we can let them know they have been heard, even if we can't fully explain their experiences.
- Be upfront with patients about expectations, limitations, and boundaries. Consider letting patients know the length of appointments, if you are able or willing to block additional time when necessary, and the ground rules for communication between visits or for lab results.
- Be willing to get curious and rethink situations. Psychologist Adam Grant, PhD, recommends staying humble, maintaining a healthy sense of skepticism, and approaching the world with curiosity. Despite knowing now more than we have ever known about the human body and physiology, our work is not done.
More necessary than ever, we need to continue to work towards system-wide change that allows physicians the ability to practice the art and science of medicine in partnership with our patients.
The real goal? A win-win-win solution with healthy patients and physicians and a lower cost of care.
is a clinical assistant professor of Allergy/Immunology at the Ohio State University Wexner Medical Center. She is the CEO/founder of The Crunchy Allergist, LLC.