Have you ever gone to a medical appointment, knowing and feeling with certainty that something is wrong, only to have a doctor downplay and write off your symptoms?
Medical gaslighting, a relatively new, non-clinical term, refers to the practice of minimizing or dismissing a patient’s symptoms, concerns, or experiences. Often, symptoms are written off as psychological in nature, or patients are told that what they are experiencing isn’t serious or that it is normal.
The problem of medical gaslighting and its downstream effects on care and clinical outcomes is long-documented—and it’s a phenomenon that disproportionately affects women, particularly women of color. A study released nearly two decades ago showed that women are systematically prescribed lower amounts of pain medication after reporting similar levels of pain compared to their male counterparts. Research confirms that when male and female patients express the same amount of pain, observers view female patients’ pain as less intense. Black women are particularly susceptible—studies as recent as 2016 showed that almost half of first- and second-year medical students believe Black patients had “thicker skin” than white patients, and a 2019 study found that Black patients were 40% less likely to receive medication for acute pain and 34% less likely to be prescribed opioids.
The inherent belief that women are more sensitive and prone to exaggerate pain isn’t just baked into our medical system—it’s baked into our very language. The word “hysteria,” in fact, comes from the Greek word for uterus, “hystera.” There’s still widespread beliefs in the medical community that anytime a woman complains about her health, it’s either related to her hormones or it’s in her head.
To understand how this came to be it’s important to understand that even fields like obstetrics and gynecology were, until very recently, dominated by male physicians. The ones writing the textbooks, teaching medical school classes, conducting research and diagnosing conditions shared none of the anatomy in question with their patients. Much of this legacy still remains. Endometriosis, for example—a condition that affects one in 10 women, causing severe menstrual pain and heavy periods—isn’t diagnosed on average for eight to 12 years after symptoms begin. In a survey of women later diagnosed with endometriosis, approximately 60% of women were told by one or more physicians—including gynecologists as well as PCPs—that nothing was wrong.
Medical gaslighting isn’t limited to obstetrics and gynecology. Chest pain is deemed psychological, ADHD symptoms are ignored, and strokes are missed. In addition to dismissing or minimizing the complaints of women, part of the problem is that much of medical science is based on the belief that males and females differ only in terms of reproductive organs. As a result, the outcomes of clinical research which was largely conducted on men and apply it to women while failing to recognize that sex affects cell physiology, metabolism, and many other biological functions; symptoms and manifestations of disease; and responses to treatment. The fact is that women have been researched much less and we know less about them.
The medical gaslighting that women experience is rooted in hundreds of years of bias and imbalance. But it’s not unfixable—it’s just not solely one person or institution’s job to address it. It takes a multi-prong approach, requiring buy-in, understanding, and action from a set of key stakeholders:
It’s incumbent upon doctors to listen faithfully to their patients and take their concerns seriously. A good first step is learning about gender bias in healthcare and taking steps to identify and combat gender bias.
Additionally, doctors should re-examine procedures that have long been considered routine that involve no pain management or control. When it comes to procedures like IUD placements, endometrial biopsies, and cervical cancer screening, doctors and patients have been trained to just get it over with quickly and deal with the pain. But is that the best path? Doctors should recognize that these can be traumatizing experiences for patients and consider them in that context.
Finally, there are small, empathetic gestures that can build trust. Taking the time to ask patients for permission before touching them, offering multiple sizes of speculums, or ensuring that instruments aren’t freezing cold, clearly demonstrates that doctors have patients’ comfort at top of minds.
If I have a single piece of advice to offer to a patient, it’s this: You know your body better than any healthcare provider. When patients are convinced something is wrong, they are often right. Patients should feel comfortable not only trusting their own brains and bodies but vocally advocating for themselves when it comes to doctor-patient interactions. Denied a test? Ask the provider to document that they declined the test. Feeling as though you aren’t being listened to? Never be afraid to seek out a second—or third—opinion.
Likewise, patients shouldn’t be afraid to seek out education. Online communities can be valuable sources of information and support, and repositories of literacy and advocacy guidance are available online and through women’s health applications and solutions.
For health plans and employers
Health plans and employers have a similar role to play when it comes to tamping down the practice of medical gaslighting. Namely, it comes through education. Through benefits and services, employers and plans can provide educational resources like digital health solutions that allow patients to research conditions, access expert advice, and seek out communities of people in similar situations.
Online community building is a powerful force when it comes to democratizing medical information. By investing in or providing access to key resources like applications and education, plans and employers can allow patients to better understand conditions, learn how to advocate for themselves, understand what tests they should seek out and, critically, better identify and stop medical gaslighting as it happens.
Charting an end to medical gaslighting
For as long as doctors have been treating patients, some small portion of them has also been failing patients. Particularly for demographics that have been traditionally disenfranchised, visiting the doctor’s office carries with it some risk that they’ll be ignored, questioned, and not taken seriously.
Hopefully, we’ll see instances of medical gaslighting fade in obstetrics and gynecology as the clinical ranks are increasingly filled by women who better understand patient experience, and have received medical education that includes gender bias education and as the clinical world, in general, becomes more focused on whole person health and patient experience. But it’s not enough to wait for that to occur organically. Payers, employers and even patients need to do their part to get educated and improve health literacy and advocacy. By taking action across every stakeholder and corner of the industry, it’s possible to curtail medical gaslighting wherever it happens—now.
About Dr. Leslie Saltzman
Dr. Leslie Saltzman is the Chief Medical Officer at Ovia Health. Saltzman has more than 15 years of experience in clinical and business technology settings. She most recently served as vice president of medical at TrialSpark, where she oversaw a team providing cross-functional support across business development, product and operations. Saltzman has a proven passion and commitment to women’s health, having held the positions of chief medical officer and clinical advisor at Rittenhouse Women’s Wellness Center.