We didn’t start the fire…or did we?—a narrative review of medical gaslighting and introduction to medical invalidation

Summary & key facts

This paper reviews what people call “medical gaslighting” and how it might show up in gastroenterology. The authors find the term is used more often but is not well defined in medicine. They say no studies have directly measured gaslighting in chronic digestive diseases. The paper proposes adding the term “medical invalidation” to cover situations where a patient’s experience is dismissed even if the provider did not intend harm. The authors describe many possible causes (patient, provider, and system factors) and note that these interactions can harm trust and care.

Key facts:

• Gaslighting is defined here as behaviors that make a person doubt their own lived experience or ability to judge that experience.
• The authors found no studies to date that specifically evaluate medical gaslighting in chronic digestive (gastroenterology) diseases.
• The review proposes using the term “medical invalidation” to capture dismissal of patient experience when intent to harm is unclear, and treats medical gaslighting as existing on a continuum.
• About 15–25% of medical consultations are estimated to involve patients labeled as “difficult” in the literature cited by the authors.
• In studies of chronic digestive illness, the odds of a patient being labeled “difficult” were higher for those with stomach pain, fainting, loose stools/diarrhea, palpitations, and sleep problems.
• The authors report that clinicians’ emotional reactions (for example guilt or impatience) can reduce time spent on problem solving and diagnostic accuracy, which may appear as dismissive or invalidating behaviors.
• This article is a narrative review based on searches of PubMed, PsycInfo, Google Scholar, and HOLLIS carried out from October 1, 2023 to January 15, 2024.

Abstract

An important distinction for medical gaslighting from other forms of gaslighting is the role of intent. As such, we propose the term "medical invalidation" be added to this construct and conceptualize medical gaslighting as occurring on a continuum. Within each facet of the relationship between system, provider and patient there are opportunities to prevent and recover from the occurrence of medical invalidation/medical gaslighting.

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Climate Change and Health Impacts

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Art Intensive care medicine Literature Medical education Medicine Narrative Narrative review Traditional medicine

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