Reflections on Gaslighting
Summary
Reflections on Gaslighting draws on The British Medical Association’s; ‘Doctor-Patient Relationship Toolkit,’ which I will be using to reflect on the incidents that I wrote about in my two recent blog posts about being gaslighted by medical consultants. In this Toolkit, The British Medical Association (BMA) clearly sets out the legal requirements, rules and principles, relating to the doctor-patient relationship, which health professionals are encouraged to use, when faced ethical decision making.
‘Good doctor-patient relationships are characterised by mutual respect, open and honest communication, and respect for the dignity and choices of patients.’
Key Principles
The British Medical Association, (BMA) states that ‘the onus is principally on the health professional to make the contact with patients work well. The basic principles underpinning the doctor-patient relationship are;
- Treating one another with respect and honesty, although doctors have particular duties to patients rooted in their professional status.
- Doctors must make the care of their patients their first concern.
- Good communication requires openness, honesty and an ability to listen.
In key patient-facing principles, the BMA says that in the guidance set out by The General Medical Council, (GMC) in Good Medical Practice, doctors ‘must,’
- Make the care of the patient their first concern.
- Treat every patient politely and considerately.
- Listen to patient’s and respect their views.
- Give patients information in a way that they can understand.
- Be honest and trustworthy.
The Duty of Care
The BMA explains in it’s Toolkit that doctors have a legal and ethical duty of care. ‘A duty of care is an ethical, legal and professional obligation to promote the health and well-being of patient’s whilst they are in their care. This means acting in the best interests of patients, and not acting, or failing to act, in a way that causes harm.’ It identifies that The duty of care begins when a doctor or other health professional engages with a patient and continues until one party ends the relationship.
‘Legally, health professionals have a duty of care when they assume responsibility for the patient, such as when a patient is added to a general practitioner list. In secondary care, it may be acceptance onto a caseload.’
Communication and Honesty
In the chapter, Communication and Honesty, the BMA clearly states that good communication and honesty between health professionals and patients are fundamental to Good Medical Practice. It says; ‘Good communication is about establishing positive inter-personal relationships, as well as exchanging information. A failure to appropriately communicate can not only result in conflict, and a breakdown of trust between the patient and the health professional, it is a significant factor leading to patient harm.’ The four most common communication failures by doctors that led to patient harm were;
- A failure to provide patients with appropriate information.
- A failure to keep colleagues informed/sharing of an appropriate level of information.
- A failure to listen to the patient.
- A failure to work in partnership with the patient.
The British Medical Association says that factors for good communication are hearing and understanding patient views, which is a vital part of the doctor-patient relationship. It’s guidance states that health professionals can demonstrate effective and respectful communication with patients by;
- Exploring the patient’s understanding, thoughts and worries about the problem and taking the patient’s input seriously.
- Being approachable and friendly.
- Showing genuine care, and being respectful.
- Being specific and checking patient understanding.
My Experiences
In my two recent posts, Medical Gaslighting #1 and #2, I outline incidents, in which consultants spun the truth when I asked them questions about radiology images. I was asking rational questions, in an attempt to better understand my condition. On leaving these consultations, I felt terrified and was left questioning my own judgement. During these consultations, I did not feel that the consultants treated me with respect or honesty. They certainly did not make the care of me, the patient, their primary concern. They seemed to make colluding with their colleagues’ opinion of me their primary concern.
In summary, these incidents included; 1) A consultant telling me that an image of my face was my spine, 2) A consultant telling me that what I saw on his computer screen was a figment of my imagination, and 3) A consultant in England telling me that a CT image from a scan, done in Scotland, which showed visible facial asymmetry was because my ‘face was lopsided in the scan machine.
The final incident involved a consultant refusing to explain to me what the abnormality, that had been detected on an MRI scan and written in a radiology report, meant. The consultant went on to tell me that what I could see in a scan image was ‘coincidence.’ Most alarmingly, he told me that the quality of my iPad was s**t, when I asked him to explain the visible facial asymmetry in CT radiology images, which I have been trying to get answers to since July, 2021.
Reflections
None of these behaviours, summarised above, adhere to the BMA guidance. There was no open and honest communication. Every question that I asked, I was shut down. The consultant, who told me that my facial asymmetry was because my head was ‘lopsided in the scanner,’ did not see me go into the machine. He knew as well as I did, that that was not true. This example is one of neither ‘open’ nor ‘honest’ communication. Nor is the example of the Oral Maxillofacial surgeon in Scotland, who told me that my face was my spine. This was inaccurate information. It was not trustworthy behaviour.
The BMA draws on the GMC’s Good Medical Practice, which says that a doctor ‘must’ treat every patient politely and considerately and give patients information in a way that they can understand.’ The incident in which a consultant told me that the quality of my iPad was s**t was rude and offensive. I also found the consultant telling me to ‘stop shopping around,’ deeply insulting. Neither examples are of polite or considerate behaviour.
The consultant telling me that the clear abnormality in a scan image was due to ‘coincidence,’ was not being honest. Going on to then photoshop the images, so that the data on the scans changed is far from trustworthy behaviour. It is decidedly dishonest. I did not receive any answers from him about the abnormality, that was reported from my MRI scan. I still have no explanation about this detected abnormality. The consultant was withholding information from me, not ‘sharing an appropriate level of information,’ as he was supposed to do.
Impact of Gaslighting
These incidents did not involve the consultants being approachable, friendly or specific. I felt terrified when I was in the room with them. On leaving all of these meetings, I was in a state of despair and confusion. I also felt undermined. The consultants neither ‘listened’ to me, nor ‘respected’ my views. They all raised their voices. Their failure to communicate with me honestly and respectfully, or give me information that I asked for, not only led to a breakdown of trust, but it caused me considerable harm. My distress levels were acute, and I have since become withdrawn and low in mood.
I have been left traumatised from these incidents. Gaslighting incident number 4 has taken me many months to recover from. It has involved me being unable to sleep at night, getting repeated flashbacks, and it has left me feeling isolated. I have felt decidedly powerless and unable to tell anyone what happened. Fear is the word that best describes how I have felt during and after these gaslighting incidents. Nothing of what I experienced adheres to the BMA guidance, as cited in their ‘Doctor-Patient Relationship Toolkit’ about how to foster positive relationships with patients.
Conclusion
In an article, called Turning Down The Flame on Medical Gaslighting, Shravani Durbhakula and Augustus Fortin, explain that in order to turn down the flame on medical gaslighting, medical professionals need to do a better job of exploring the ‘biopsychosocial model with patients.’ The article argues for a need to focus on relationship-centred communication.
Patients who feel heard, understood, and cared-for will not feel gaslighted; and with proper dialogue, it is more likely that physicians will order the right tests and therapies when they are indicated. Over 40 years of research have shown that using relationship-centred communication skills achieves this, and more5,6. These skills are linked with improved health outcomes and better patient experience. Importantly, these skills can be incorporated into practice with modest effort. Key evidence-based skills include collaborative agenda-setting for the encounter, allowing patients to describe their symptoms without early interruption, eliciting the emotional context of that story, and responding with verbal empathy.[1]
Jennifer Huizen, writes in Medical News today that ‘over time, a person who is a victim of gaslighting may start to believe that they cannot trust themselves, or that they have a mental health disorder.’ This may lead to:
Jennifer Huizen states that all of these can have a long-term impact on someone’s mental health and self-esteem. They may also make it more difficult for the individual to leave an abusive situation.
Foot Notes
[1] Durbhakula, S and Fortin, AH; Turning Down The Flame on Medical Gaslighting, The Journal of General Internal Medicine, July, 2023.
Recommended Articles
How To Spot Medical Gaslighting
Medical Gaslighting; The Women Not Listened To.
Turning Down the Flame on Medical Gaslighting
The Doctor-Patient Relationship Toolkit