‘Validation, empathy, good communication’ key to minimize gaslighting in GI care
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Gaslighting occurs in a relationship when one person is made to feel manipulated and questions their reality. Medical gaslighting takes place when a patient’s concerns about their health are dismissed, minimized or they do not feel heard.
The invitation to write an editorial about gaslighting in gastroenterology comes at an interesting time when resources in medical settings are extremely limited, affecting both patients and providers.
Unfortunately, due to the nature of GI symptoms and conditions, this field is rife with patients who have experienced subtle (eg, a rushed clinic visit) and overt (eg, “Your symptoms are in your head — you just have irritable bowel syndrome.”) medical gaslighting.
Here is a powerful example of how gaslighting may unintentionally affect patients: A newly-diagnosed patient with IBS describes severe abdominal pain and diarrhea, which causes difficulty getting to work. Their well-intentioned gastroenterologist provides a treatment recommendation and tells the patient to schedule a 2-month follow-up. When the patient goes to schedule, they are told that the provider’s first available appointment is in 6 months.
After a situation like this, patients have shared with me feelings of being gaslit, as well as anger, invalidation, helplessness and defeat:
- “Am I crazy? I could have sworn they told me they wanted to see me in 2 months.”
- “This provider does not believe that I am really suffering.”
- “What am I supposed to do for the next 6 months with these symptoms? What if things get worse? What if I lose my job?”
- “Maybe my symptoms are not as bad as I think they are. Others are worse off than me.”
The reality is that, in most cases, the provider is not intentionally trying to invalidate the patient experience. It is a systemic problem. Providers ultimately want to provide better access, more communication and ample time to discuss treatment plans. This is difficult in a 15-minute office visit and with a panel of 5,000 patients.
The past 3 years have further fractured already stressed medical systems and added to the burden patients describe in their visits with me. In addition to mounting psychosocial stressors, patients are faced with increasing medical management concerns. As a result, behavioral health visits not only include me assessing psychological complexities, but also doing case management, in which I communicate directly with providers regarding aspects of the patient’s care that I worry will disrupt the patient-provider relationship.
Why am I going outside my role as a GI psychologist and doctoral-level clinician? Because our medical system is forcing me to. I cannot sit back and unintentionally allow sick, defeated patients to slip through the cracks or go months believing their provider does not care, when in fact, I know they do. We know that patients in GI have higher rates of anxiety, depression and trauma, which can affect how they engage with their health care team and in the medical setting.
I conceptualize cases through the lens of cognitive behavioral therapy. From this framework, we identify that how one thinks affects their feelings and behaviors. Thoughts and feelings of the patient can result in behaviors that may lead to distrust in the patient-provider relationship.
In the setting of GI, where it can take years to receive a diagnosis that may or may not come with a definitive set of biomarkers, patients place immense trust in their provider. They trust that they can be helped and that, despite the complexity of their diagnosis, the provider will guide them to resources that can improve their functioning and quality of life.
I have always believed that the relationship between a gastroenterologist and patient is special because it is often a long-term working relationship, given the relapsing and remitting nature of GI conditions.
The reality of medical gaslighting and the trauma associated with it is much deeper than scheduling issues. Here are tangible changes that providers can make to validate their patients and strengthen that sacred patient-provider relationship.
- Be mindful of your schedule. If you know you are booking out 6 months, communicate this to your patients. Then, provide them with specific resources they can utilize while working their treatment plan, such as nursing support or scheduling with an advanced practice provider.
- Validate your own emotions as a provider. Your schedule is not inaccessible by choice. This likely contributes to your own thoughts and feelings about your ability to carry out the level of care you would like. Brainstorm constructive solutions for scheduling difficulties with your practice colleagues.
- Acknowledge the limitations of your office visit time and ask patients what is most important to cover during your time together.
In the practice of GI, validation, empathy and good communication are paramount to a successful treatment plan. We must remember that while a patient may be one in 5,000, their individual experience must be considered every time you engage in their care.
- For more information:
- Megan E. Riehl, PsyD, AGAF, is the clinical director of the GI behavioral health program at the University of Michigan.
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