Medical gaslighting and diagnostic overshadowing are examples of recognised behaviour by clinicians that can lead to negative health outcomes for patients. To reduce the likelihood of these behaviours occurring, patients need to be familiar with them and the steps they can take.
The term "gaslighting" is often associated with personal relationships, where one partner manipulates the other into doubting their own mental capacity, thoughts, and feelings. The term gets its name from a 1944 film Gaslight, which follows a young woman whose husband slowly manipulates her into believing that she is descending into insanity.
What is Medical Gaslighting?
Medical Gaslighting describes a behaviour in which a healthcare professional dismisses or downplays a patient’s physical symptoms or attributes them to something else, such as a psychological condition. This can lead to missed diagnoses, delayed treatments, and negative health outcomes.
The BBC recently reported on the experience of Sophie Spindler, who faced years of "medical gaslighting" while trying to get a diagnosis for her endometriosis. Doctors frequently dismissed her symptoms as phantom pain and even misattributed them to appendicitis, resulting in her undergoing an unnecessary appendectomy. She was finally diagnosed with endometriosis in 2015 and has undergone surgery. Since then, Sophie has given birth to two boys following an NHS-funded IVF cycle.
Potential Causes
The question arises: why does gaslighting occur in healthcare? Dr Marron a physician and director of clinical ethics at the Harvard Medical School Centre for Bioethics in the US provides a couple of reasons.
- One reason is that a patient has an illness that is not well understood. This lack of understanding can lead a doctor to dismiss the patient's symptoms as unimportant, reflecting their own uncertainty or insecurity.
- Additionally, conscious or unconscious bias plays a role in medical gaslighting. Research indicates that individuals from marginalised groups, especially women and people of colour, are more likely to have their concerns or questions taken less seriously, which can lead to poorer health outcomes.
What is Diagnostic Overshadowing?
Another phenomenon that can lead to negative health outcomes is diagnostic overshadowing. This phenomenon occurs when a healthcare professional attributes a patient’s symptoms to a pre-existing condition, leading to a misdiagnosis or delayed diagnosis of a separate, treatable issue.
The NHS clearly recognises this in Guides for patient management produced which explain that diagnostic overshadowing “…occurs when the symptoms of physical ill health are mistakenly either attributed to a mental health or behavioural problem or considered inherent to the patient’s learning disability or autism diagnosis.” For example, a patient with a learning disability may report pain, but the healthcare provider might dismiss it as part of their disability, failing to properly investigate the pain and its underlying physical cause.
Avoiding Medical Gaslighting and Diagnostic Overshadowing
Experiences of medical gaslighting and diagnostic overshadowing will likely undermine a patient’s trust in the healthcare system, making them less likely to seek care in the future.
In respect of medical gaslighting, Dr Marron advises going to an appointment as prepared as possible and to consider bringing:
- a journal tracking the symptoms that one has been having;
- a brief and precise expression of the medical concerns; and
- a short list of questions for the clinician.
In respect of diagnostic overshadowing, the onus is on healthcare professionals to carry out thorough and appropriate assessments and for healthcare providers to provide up-to-date training to healthcare professionals as to how to assess patients with mental health conditions.
There are various guidelines set by the NHS and NICE which include useful links for healthcare professionals, including NCAPC (Non-Communicating Adults Pain Checklist) which is an 18-item check list to assist healthcare professionals to assess chronic pain in non-communicating adults, for example.
However, equally appliable to both medical gaslighting and diagnostic overshadowing is having a family member or friend who can be present at appointments, observe the interaction with the clinician and act as an advocate if necessary. If the patient has no one who they can bring, it is recommended to search for local support groups and organisations who can act as an advocate and represent the patient’s views.
Trainee Solicitor, Yusuf Takoliya observes: “It is important to understand situations that can lead to negative healthcare outcomes, such as medical gaslighting and diagnostic overshadowing. To reduce the likelihood of these instances occurring, it is crucial for patients to be familiar with the steps they can take. However, patients are often at their most vulnerable when visiting a healthcare professional. Therefore, it is the responsibility of health professionals to be attentive and considerate of what patients share, ensuring that they do not dismiss or make assumptions about their medical conditions.”
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If you have concerns about the medical care that you or a family member has received, please contact our specialist team for a no-obligation consultation on 0116 254 7456 or at enquiries@moosaduke.com .
