In 1938, a play hit the stage about a man attempting to make his wife believe that she was going insane. One of his methods involved causing their home’s gas lights to dim, but then insisting to his wife that the lighting was normal. The name of the play? Gas Light.
Today, the term coined from that play — gaslighting — refers to the psychological manipulation of a person over an extended period of time, in a manner that causes the victim to doubt the validity and integrity of their own perceptions, thoughts, memories, and reality. Over time, gaslighting causes victims to feel confused, lose their confidence, question their emotional or mental stability, and become dependent on the perpetrator to tell them what is fact and what is fiction.
Gaslighting, which was recently declared Merriam-Webster’s word of the year for 2022, is not a new phenomenon, nor is it limited to a specific scenario or relationship. It occurs in families, workplaces, social groups — and the list goes on. While all gaslighting is a form of abuse, there is an especially unethical, patently dangerous, yet alarmingly widespread application that takes place daily in the healthcare field.
What is Medical Gaslighting?
Medical gaslighting occurs when patients feel that their symptoms, concerns, observations, and other details and experiences about their health are dismissed and minimized by physicians. While the toxic power dynamics of medical gaslighting is not restricted to a particular demographic, it disproportionately affects women. For instance, multiple research studies have found that compared with men, women:
- are more likely to be misdiagnosed;
- are twice as likely to be given a mental health diagnosis;
- face longer wait times for cancer or heart disease diagnoses;
- are 7x more likely to be discharged from the ER in the midst of a heart attack;
- are treated less aggressively for chronic pain, traumatic brain injury, and autoimmune issues; and,
- must wait longer for pain medication when experiencing severe distress.
While medical gaslighting does not explain all of these differences, it is well documented that female patients' complaints are often minimized as compared to those of males.1 Medical gaslighting also disproportionately impacts people of color. For instance, a 2019 study published in The American Journal of Emergency Medicine found that compared to white patients, black patients in the U.S. were 40 percent less likely to receive medication for acute pain, and 34 percent less likely to be prescribed opioids.
"We know that women, and especially women of color, are often diagnosed and treated differently by doctors than men are, even when they have the same health conditions," noted Karen Lutfey Spencer, a researcher who studies medical decision-making at the University of Colorado.
Addressing Medical Gaslighting
According to orthopedic surgeon Thomas Fleeter, MD, MBA, FAAOS, the “ultimate method to address medical gaslighting is to switch physicians.” In theory, this is good advice. But in practice, it can be difficult for patients to reach this conclusion and take this major step; especially since one of the insidious characteristics of medical gaslighting is that it is typically subtle, covert, and systemic. What’s more, some physicians do not consciously realize that they are engaging in medical gaslighting. Yet despite these obstacles, there is a technology-driven solution that could significantly help level the playing field: digital therapeutics.
What Are Digital Therapeutics?
Digital therapeutics can deliver health care directly to patients using evidence-based, clinically-evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders, such as high blood pressure (hypertension). Writes Dr. Sanchari Sinha Dutta, Ph.D.:
Digital therapeutics provide improved and long-lasting health outcomes by applying scientifically-developed technologies that monitor all aspects of treatment progression as well as the changes in patients' behavior. These technical applications can encourage patients to follow prescribed treatment regimens, diets, and exercise routines. The software used in digital therapeutic products must be equipped with accurate and appropriate evidence and should be able to prevent and manage diseases.
The Fight Against Medical Gaslighting
There are some key ways that digital therapeutics could help in the fight against medical gaslighting:
- Digital therapeutics can track detailed and accurate health data. Patients can use this objective information to advocate for themselves, conduct more research or get a second opinion. For example, a shareable physician report that includes a detailed log of medication tracking would help address claims of non-adherence to medications.
- Digital therapeutics can facilitate greater patient involvement in their overall health care, for example by providing education on a topic or suggestions in an unbiased way. In turn, this can give patients knowledge, clarity and confidence. At the same time, a growing body of evidence shows that patients with higher activation (i.e., the knowledge, skills, and confidence to become actively engaged in their health care) have better health outcomes.
- Digital therapeutics can help patients ask smarter, more relevant questions. This in turn can make communication with their physician more efficient, and may prevent misunderstandings and assumptions from being incorrectly perceived as medical gaslighting. Comments family physician Dr. Mikhail Varshavski: “Labeling something gaslighting can actually become a self-perpetuating prophecy…Basically, without getting offended — which is very difficult and puts more emphasis on what you have to do as opposed to what the provider really should be doing — say, `OK, I need to ask questions and make it clear to the provider that I still don't understand what's going on’…If you still get shut down, then you have no choice but to look for a second opinion.”
How Organizations Can Help Their Members
Employers can make digital therapeutics available to their workforce as part of the organization’s benefits offering. This enables three key objectives:
- Members can potentially use digital therapeutics to help identify and address medical gaslighting with shareable physician reports of their tracked health data, and can use them to help reframe the relationship with their physician. Commented Dr. Jennifer H. Mieres, a professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell “Gaslighting is real; it happens all the time. Patients — and especially women — need to be aware of it.”
- Members can use digital therapeutics to track, control, and improve their health and wellness to achieve better health outcomes on their own terms — which is, after all, the core aim of any health benefits offering. For example, a peer-reviewed study published in 2021 in JAMA Network Open found that 84 percent of employees who used Hello Heart’s digital health coaching app,4 and who had a baseline blood pressure over 140/90 (stage 2 hypertension), reduced their blood pressure and sustained that improvement for up to three years. Furthermore, the average reduction in systolic blood pressure was 21 mmHg, which represented a 2x greater improvement compared to any other digital heart health solution.2
- Digital therapeutics could contribute to health equity, which is important given the prevalence of medical gaslighting for women and POC. For example, in an Abstract published in the American Heart Association’s Hypertension Journal, equitable clinical outcomes were observed for Hello Heart users across gender, age, race, and preferred language groups, indicating that digital self-management programs like Hello Heart can help level the field when it comes to DEI in heart health.3
The Final Word
Medical gaslighting — like gaslighting itself — is not a new phenomenon. However, thanks in large part to the massive communication ecosystem that is “the internet,” more people are talking about it; from physicians who are calling out their peers, to patients who are bravely sharing their medical gaslighting experiences as a way to educate and empower others.
Organizations that make digital therapeutics available to their workforce have the opportunity — and some might add the obligation — to be part of a larger solution that may one day extinguish medical gaslighting once and for all.
1 Zhang, L. (2021, September). Gender Biases in Estimation of Others’ Pain. Retrieved from https://www.jpain.org/article/S1526-5900(21)00035-3/fulltext
2 Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed December 19, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. This study showed that 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163 were able to reduce their blood pressure by 21 mmHg using the Hello Heart program.) (2) Livongo Health, Inc. Form S-1 Registration Statement. https://www.sec.gov/Archives/edgar/data/1639225/000119312519185159/d731249ds1.htm. Published June 28, 2019. Accessed October 19, 2022. (In a pilot study that lasted six weeks, individuals starting with a blood pressure of greater than 140/90 mmHg, on average, had a 10 mmHG reduction.) NOTE: This comparison is not based on a head-to-head study, and the difference in results may be due in part to different study protocols.
3 Roberts J, Roach B, Gazit T, Mark S, Aggarwal S. Abstract P302: Efficacy of a Digital Hypertension Self-Management and Lifestyle Coaching Program in Reducing Blood Pressure Across Sex, Language and Racial Groups. Hypertension. 2022;79:AP302. https://www.ahajournals.org/doi/10.1161/hyp.79.suppl_1.P302. Accessed November 1, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. Findings have not been subjected to peer review.)
4 Hello Heart’s digital coaching encourages healthy lifestyle choices that are generally recognized to help reduce the risk of cardiovascular disease.
Hello Heart is not a substitute for professional medical advice, diagnosis, and treatment. You should always consult with your doctor about your individual care.
1. Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed October 19, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. This study showed that 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163 were able to reduce their blood pressure by 21 mmHg using the Hello Heart program.) (2) Livongo Health, Inc. Form S-1 Registration Statement. https:/www.sec.gov/Archives/edgar/data/1639225/000119312519185159/d731249ds1.htm. Published June 28, 2019. Accessed October 19, 2022. (In a pilot study that lasted six weeks, individuals starting with a blood pressure of greater than 140/90 mmHg, on average, had a 10 mmHG reduction.) NOTE: This comparison is not based on a head-to-head study, and the difference in results may be due in part to different study protocols.
2. Validation Institute. 2021 Validation Report (Valid Through October 2022). https://validationinstitute.com/wp-content/uploads/2021/10/Hello_Heart-Savings-2021- Final.pdf. Published October 2021. Accessed October 19, 2022. (This analysis was commissioned by Hello Heart, which provided a summary report of self-fundedemployer client medical claims data for 203 Hello Heart users and 200 non-users from 2017-2020. Findings have not been subjected to peer review.)