While medical gaslighting can and does occur, you’re not powerless against it. Here are some ways to lessen the likelihood that it will occur, and to respond if you experience it.
Before the Visit
Check reviews. Consumer websites rate providers on everything from waiting time to bedside manner. Reading between the lines can reveal if a physician approaches patients with bias or is prone to gaslighting, say experts. Such summaries are collected on DocInfo.org, Vitals, Doctor.com, ZocDoc, Healthgrades, and Yelp. It’s important to remember that listings reflect opinions, not objectively verified problems.
More objective criteria exist on the website of the Federation of State Medical Boards (FSMB), which reviews medical credentials and publishes disciplinary actions taken against doctors. For reviews of hospital in-patient experiences, the Hospital Compare website examines institutional performance, assessing hospitals’ ability to address patient needs and fully explain treatment options.
Look for culturally competent providers. It’s not easy to find a doctor you can relate to. Personal referrals from friends or family are often a surefire way to go, but some organizations also have devised specific ways of connecting people with doctors who either share a similar background or are known to be culturally sensitive. Among them: Health in her Hue, the National Medical Association, the Association of American Indian Physicians, the National Council of Asian Pacific Islander Physicians, and the National Hispanic Medical Association.
Write down questions. During a stressful appointment, when facts fly at a fast and furious pace, it’s easy to forget details. Draw up a list of questions before the visit, and bring a pen and paper to capture the answers. “Everyone should do that, particularly when dealing with life-altering conditions,” says Eucharia Borden, vice president of health equity at the nonprofit Cancer Support Community.
Bring a buddy and witness. Line up an extra pair of eyes and ears to serve as a witness and discussion partner. “It’s very helpful to have someone with whom to review and talk about what you’ve both heard,” says Leeann Medina-Martinez, the disparities program coordinator for the national nonprofit CancerCare.
Understand your rights. Hospitals, clinics and many medical practices adhere to a “Patient Bill of Rights” that guarantees freedom from discrimination based on race, color, religion, sex, gender identity, national origin, disability, or sexual orientation. Providers are usually required to post details in a prominent place, and to offer printed versions. Be prepared to seek out the information or to ask for a printed copy.
At the Visit
If you sense it, ask for time to talk it over. Medina-Martinez advises anyone who feels uncomfortable, overlooked, or demeaned to take the issue to the source in a calm, nonconfrontational way. “Not every patient has the confidence to push back, but I can tell you that patients who do so generally get results, find answers, and achieve a better outcome,” she says.
If the provider is unwilling to talk, or if the conversation is unsatisfying, she suggests that the individual seek the name of another provider, an option usually guaranteed in the “Bill of Rights.” “People should advocate for themselves and take things to the next level, if needed,” says Medina-Martinez.
Medicare recipients and those covered by most private insurance providers are also entitled to get a second, or even a third opinion. In many cases, the institution can deliver those as virtual second opinions via conferencing software.
Find a treatment team ally. Sometimes, a sympathetic treatment team member can help weigh in on whether an incident constituted bias. For patients already in the hospital, a charge nurse may be the way to go, says Borden. But you may need to follow your gut on this one, says Gore. “Oftentimes, those in lower positions on the team will defer to the main provider and may fall in line with what they do, even if it’s not necessarily the right thing to do.”
Seek out a social worker. Some social workers are specifically trained to help patients troubleshoot issues from financial counseling to suspected discriminatory treatment. “We’re trained to meet people where they are, and there is so much we can do by working in tandem with the healthcare team,” says Borden.
Find a patient advocate. Most hospitals and many medical practices staff departments, offices, or individuals as liaisons between those receiving and providing care. “Where I work, these people are part of the ‘patient experience team,’ but it can go by different names,” says Borden.
Whether called patient representatives, patient liaisons, crisis resolution specialists, patient advocates, or ombudsmen, these trained professionals take on all kinds of concerns. A nurse navigator is also an option, says Gore. “A nurse navigator is sometimes able to address the care team in ways that the patient cannot,” she says.
After the Visit
Connect with an outside group. Many nonprofits provide free advice and support to patients. For example, the Patient Advocate Foundation offers free case management through one-on-one support to patients and families dealing with a serious medical condition. Additionally, the National Association of Free & Charitable Clinics offers wide-ranging services including a free or low-cost healthcare provider directory. Finally, most social workers usually keep lists of local groups, support organizations, and advocates.
File a complaint. Federal and state government organizations stand ready to accept civil rights grievances. To find the right office, check out the rights grievances Centers for Disease Control and Prevention’s (CDC) searchable list covering all 50 states and territories. The U.S. Department of Health and Human Services can share guidance on possible violations by phone 800-368-1019 or by emailing [email protected]. Be sure to review their guidelines before pursuing action.
In addition, Medicare recipients can appeal a too-hasty hospital discharge through the Quality Improvement Organization (QIO). Carefully read the online explanation entitled “An Important Message from Medicare” before proceeding. A discharge is paused while the filing is pending. Finally, the Joint Commission on Hospital Accreditations provides an online complaint form for consumer concerns and takes calls at 800-994-6610. The commission examines and certifies roughly 80 percent of American hospitals.
Consult an attorney. The Legal Services Corporation, LawHelp.org and Law Help Interactive, or the American Bar Association can help locate free legal advice for civil rights violations. Churches, local governments, and some local lawmakers may also be able to pinpoint pro-bono legal resources. This option should be considered a last resort, since these cases often take years to resolve and can undermine healthcare providers‘ ability to practice. Gore says she’d save this option for “gross negligence with a paper trail.”
Despite the stubborn persistence of some forms of unequal treatment, more providers are not only becoming aware of hidden bias but are expected to take concrete actions to eliminate it. “These problems are not as common as they have been because people are talking about it and ringing the alarm,” says Medina-Martinez. “Because of that, I believe everyone is becoming more conscious and more careful about making sure they’re providing equal services.”
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