By Genni Burkhart
Coined as Merriam-Webster's 2022 word of the year, "gaslighting" refers to a type of deception, specifically, the psychological manipulation of someone over time that causes them to question their memories, thoughts, feelings, and perception of reality.
"Medical gaslighting" happens when healthcare professionals dismiss, marginalize, or ignore a patient's health concerns. Consequently, it has a profound and detrimental effect on a patient's emotional and physical wellbeing and undermines their trust in the healthcare system. Medical gaslighting is particularly damaging because it results in prolonged suffering, misdiagnoses, inappropriate treatments, and delayed diagnoses – all of which have severe physical and mental health consequences.
As licensed medical professionals, dentists must follow the highest standards of care. By understanding this issue and its harmful implications, dentists can develop strategies to safeguard their patients and dental practices against it.
The term gaslighting comes from the 1938 British stage play Gas Light, which became the 1944 movie Gaslight. In the film adaptation, Ingrid Bergman plays the protagonist whose husband tricks and manipulates her into thinking she's losing her mind via the dimming of a gas lantern.
If you're considering adding this to your weekend watchlist, pay attention to the opening and closing credits displayed over the flickering light of a gas lamp. Look closely at the shadows on the wall, and you'll see the image of a man strangling a woman. Yes, rather intense, but this movie perfectly illustrates (through art) the subtle yet destructive effect of gaslighting on women.
From females to people of color, LGBTQ, and elderly patients, this is an even greater problem, and it's more prolific than one might initially think. According to a recent New York Times article by Melinda Wenner Moyer, women wait longer to be diagnosed with heart disease and cancer and are much less likely to be given pain medications.
There is a lot to consider here, so let's examine some statistical findings supporting this issue.
- According to a TODAY/SurveyMonkey poll from 2019, 17% of women felt they were treated differently by their doctors due to their gender. Only 6% of men said the same.
- In the same survey, over a quarter of women with chronic health conditions reported that their symptoms had been ignored or dismissed by a healthcare provider, and 1 in 4 women with chronic diseases said that a healthcare provider didn't take their pain seriously. Almost a third felt they had to "prove" their symptoms.
- According to a 2018 study of 12,147 outpatients with atrial fibrillation, approximately 25% fewer Black people were treated with oral anticoagulants, and 37% were less likely to receive the safer, easier-to-use oral alternative.
- A 2022 research article by The University of Chicago found that Black patients, particularly females, had 2.54 times the odds of being described negatively in the history and physical notes of their medical records, showing how racism and bias are communicated in electronic health records (EHRs).
- In a 2020 study published in the Journal of Neurotrauma, women with traumatic brain injuries (TBIs) were found to be treated less aggressively than men, were more likely to be discharged home, and had less access to general trauma care following a TBI than men.
- Academic Emergency Medicine published a study finding that women with severe stomach pain waited almost 33% longer than men with the same symptoms in emergency rooms.
Robert Alfonso Duarte, MD and Director of the Pain Institute of Neurology, Long Island Hewish Medical Center, explains in an article for Northwell Health that chronic pain is complex, and every patient – regardless of gender or sex – needs a comprehensive evaluation that also includes a psychological assessment.
In the same article, Stephanie Trentacoste McNally, MD Obstetrics and Gynecology, remarks on the implicit belief in the medical community that whenever a woman complains about her health, it's either a result of her hormones or "in her head." Dr. Duarte emphasizes that hormones are too often associated with chronic pain in women. There is some association, he explains, but "they aren't responsible for many of the ailments women face."
Thankfully, there is some good news. Interest is growing in understanding how sex and gender influence health. Medical schools are beginning to discuss in their educational curriculum that the "all-for-one" approach to medicine negatively impacts women's health.
Regarding dentistry, studies show how sex and gender impact oral health. There is a large amount of literature on pain, which carries over into the context of dentistry for obvious reasons. As a result, gender-specific dentistry has become more relevant, as is the need for more research to support this theory.
Stereotyping Lurks Behind Medical Gaslighting
There's evidence that stereotypes form early in a person's life.
As humans, we instinctively group others into categories like age, weight, skin color, gender, sexual orientation, social class, and even linguistics, according to researchers. This unconscious bias is ingrained in human nature and is meant to help us navigate the world. However, the unconscious or conscious feelings we develop about people we place in these categories can cause underlying bias and prejudice, leading to serious consequences. When this bias enters the doctor/patient relationship, patients feel unheard and invalidated, leading to frustration, further health issues, and mistrust.
The most effective way to avoid any implication of medical gaslighting is to prevent communication breakdowns with patients. Good listening skills elicit fewer misunderstandings and better exchanges of information. In addition, to ensure everyone is on the same page, actively listening and providing feedback creates a safe and healthy environment free of judgment and unconscious bias.
As Dr. Mikhail Varshavski states in an article for Insider.com, the best way to avoid medical gaslighting is to provide patients with clear information about their options, involve them in decision-making, listen to their concerns, and value their autonomy.
Regardless of gender, sexual orientation, race, religion, social or economic status, and age – encourage patients to have confidence in their own perception of medical care. Instilling this confidence in patients, particularly those at most risk of gaslighting, can help foster a sense of trust between patient and dentist, leading to greater satisfaction with their overall care experience and quality of life.
Look for more insightful articles addressing diversity, equality, and inclusion as it relates to gender-based oral healthcare, trauma-informed dentistry, and unconscious bias in the dental workplace in upcoming issues of the Incisor. If you would like to submit your own experience with this timely topic, please contact us here.
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Author: With over 13 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides on the western shores of the idyllic Puget Sound where she works as the Editor in Chief for the Incisor at DOCS Education out of Seattle, WA.