An article published in Medscape highlights the results of a review – previously discussed by ME Research UK – which identified that ‘Symptom invalidation’ by health professionals may lead to delays in diagnosis.
Regrettably, many people with ME/CFS experience symptom invalidation – also known as ‘medical gaslighting’ – which is the dismissal or minimisation of a person’s symptoms or legitimate concerns by a health professional.
Medical gaslighting can erode trust between a patient and their health professional, it can also negatively impact future health care interactions and may even lead to ‘medical trauma’ – a psychological or physiological response to a negative or traumatic experience in a medical setting.
In the Medscape article, several potential explanations were given for why physicians may gaslight their patients:
- Stress and strain of increased demands to see more patients in less time.
- Pressure to justify decisions made – and the costs associated with these decisions – such as performing treatments, ordering tests, or referring patients.
- Complex and medically unexplained symptoms do not fit neatly into categories required by health systems.
- Ambiguous symptoms – such as those experienced by people with ME/CFS – are often wrongly attributed to psychological factors.
- “When you think hoofbeats, think horses, not zebras” – a phrase which is “drummed into the heads of physicians from the first day of medical school” – encouraging them to attribute a patient’s symptoms to a common condition rather than a rare – or less common – disease.
Within the article, it is also noted that those in underserved groups may be more likely to have their symptoms dismissed, leading to longer delays in diagnosis and access to appropriate treatment for these groups.
Interestingly, the experts interviewed by the author of the article provided tips to help physicians avoid gaslighting their patients, including that they should:
- Not be afraid to admit that they do not know the answer.
- Avoid erroneously attributing physical symptoms to psychological illness.
- Practice an empathetic demeanour
- Validate experiences of the patient.
- Allow patients to ask questions.
- Trust that patients know when something is wrong with them.
The article concludes with a quote from Zed Zha, MD, a family physician and dermatologist in Washington, USA, who says, “let’s put our energies into providing patient care that is affirming and takes symptoms seriously” – something which would undoubtably improve experiences of health care for many people with ME/CFS.
The term’ gaslighting’ derives from a 1938 play ‘Gas Light’ written by Patrick Hamilton which was later adapted into a UK film of 1940 and then re-made by MGM in 1944 as ‘Gaslight’, in which a husband intentionally manipulates his wife into questioning her perceptions of reality in order to distract her from his own criminal activities.
