TURNING OFF THE GAS

Medical gaslighting is real — and destructive. Does hope for change lie in our medical schools?

By Stephanie Forté

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After eating, Kim Treviño’s stomach would become so distended that she looked six months pregnant. Her periods had always been excruciating, but severe abdominal pain had become constant. “It’s something you’re eating,” her doctor said. She tried an elimination diet and digestive enzymes. They didn’t help. Irritable bowel syndrome and colon cancer screenings were clear. For two years, as her pain worsened, she was continually tested for STDs she didn’t have. During ovulation, the pain became so intense that she’d be bedridden. It’s just period cramps, she was told.

After months of exhaustively researching her symptoms, Treviño, who is 37 and the associate development director at UNLV’s Black Mountain Institute, asked her gynecologist, “Could I have endometriosis?” Well, maybe.

Endometriosis is a condition in which tissue that lines the uterus, usually shed during menstruation, migrates to other parts of the pelvis. It causes pain, inflammation, scarring — even organs “sticking” together. The 10 percent of reproductive-aged U.S. women with endometriosis wait about a decade to be diagnosed via a laparoscopic procedure also used to treat the condition. Like Treviño, about 90 percent have had their symptoms dismissed That procedure should’ve ended Treviño’s ordeal. Instead, it unleashed a nightmarish and all-too-common occurrence for women with unresolved pain — medical gaslighting.

An age-old problem with a new name, medical gaslighting is when a doctor repeatedly dismisses a patient’s health concerns as not real, insignificant, or psychological. It’s born out of our medical culture’s rampant disregard for the pain of women and other marginalized groups of people, which has other big consequences as well: dangerous lag times for diagnosing many diseases, blame-shifting, and data disparities in research.

But there’s some hope for change in Las Vegas, where medical school leaders are working on a course correction. They’re drilling down on factors driving medical gaslighting with the hope of teaching future generations of doctors how to really listen to — and understand — their patients.

WHEN TREVIÑO’S ENDOMETRIOSIS surgery didn’t curtail her pain, she spent the following year being examined by seven gynecologists, who performed more than 30 pelvic exams, where she cried out in agony. It was excruciating for her to sit or walk for more than a short period. She was told:  Most women feel better by this time. Maybe you’re just sensitive. How about an antidepressant? It’s probably anxiety.

Doctors are gatekeepers to care, so when they don’t believe a patient who actually is in pain, it prolongs the patient’s suffering. Patients say medical gaslighting is also maddening, which makes sense since gaslighting is a form of abuse that leaves people questioning their perceptions. British novelist and playwright Patrick Hamilton coined the term in his 1938 play, Gas Light, in which a man tricks his wife into thinking she’s going insane so that he can steal from her.

Treviño was finally vindicated another year later, when an out-of-state specialist did a second surgery, confirming that endometriosis was still present throughout her abdomen, and she’d likely had it for more than a decade. But five years of having her pain dismissed has been hard to shake off. “It made me not trust my body,” Treviño says. “It made me doubt my sanity.”

Since 2017, more than 1,000 news articles have addressed medical gaslighting, in publications ranging from The New York Times to Cosmopolitan magazine. On TikTok, #medicalgaslighting has more than 250 million views. But it’s not some new social fad.

For eons, women have been considered unreliable narrators of their pain, incapable of distinguishing physical from emotional distress. Unresolved pain often gets women labeled as too sensitive, emotional, or — the age-old favorite — hysterical , from the Greek word hysteria , which means “uterus.” The ancient Greeks reasoned that women’s pain was because of uterus-related phenomena such as virginity, not having birthed a child, and even being unmarried. In the 19th and 20th centuries, men stumped by the female reproductive system fabricated convenient truths.

“It seems ridiculous now to imagine physicians once believed that a woman’s nerves were too highly strung for them to receive an education and that their ovaries would become inflamed if they read too much,” writes feminist historian Elinor Cleghorn, in her 2021 book, Unwell Women: Misdiagnosis and Myth in a Man-Made World

More outrageous is how it still affects women today.

THE SUSTAINED NEGLECT of women’s suffering signals a profound problem: We’ve accepted pain and medical gaslighting as a part of a woman’s experience. This is because of a complex system of legal, medical, and social practices that reinforce the status quo.

Women don’t have recourse when they’re not listened to, in part, because it’s not illegal to ignore them. In Nevada, even when medical gaslighting results in irreversible

Keep Our Doctors in Nevada (KODIN) was legislation passed in 2004 that created additional layers of protection for doctors, making it more difficult to file a medical malpractice suit. KODIN was supposed to improve healthcare by halting a mass exodus of physicians through lowered malpractice insurance costs. But by most measures, local healthcare has yet to improve. One thing KODIN did accomplish? Shortening the window to file a suit to one year. Because of this, some women who spoke to Desert Companion reported that their gaslighting appeared to be a tactic to avoid a lawsuit for a surgery gone wrong.

Medical gaslighting also strips women of agency and creates a sense of trepidation. A survey  by Athenahealth found that 67 percent of millennials and more than half of women of all ages have opted to withhold health concerns from their doctors for fear of being branded as a problem patient.

“My doctor littered my medical records with comments that make me out to be aggressive and difficult,” says Mary Riddel, UNLV economics professor emerita. After a hip replacement surgery, Riddel’s pain worsened. For months, her surgeon insisted the implant had been installed perfectly — she was the problem. The remarks in her records made it hard for her to get care in Las Vegas. It turned out a standard implant wasn’t a good fit for her body. A Los Angeles surgeon addressed the issue, but, because of the delay, today, the longtime outdoor athlete limps and experiences pain walking long distances.

Doctors refer to women as “complaining” about a symptom rather than “experiencing” it. And Black women are more likely to be described by negative descriptors such as “uncooperative” or “noncompliant,” which can affect treatment and outcomes.

Gender and racial bias also create blind spots for doctors. In a 2023 survey by fertility technology company Mira, 72 percent of millennial women reported having their symptoms ignored by physicians. And nearly 65 percent of the women surveyed said physicians had linked their health concerns to anxiety. According to various studies, middle-aged women with symptoms of heart disease are two times more likely than men to be diagnosed with mental illness; women under 55 are seven times more likely to be sent home while having a heart attack; and compared to men with identical symptoms in the emergency room, women with chest pain wait 23 percent longer to be seen by a physician, while those with abdominal pain wait 33 percent longer.

IT WASN’T UNTIL 1993 that Congress passed a law requiring women and minorities to be included in clinical research. And yet, since then, the data gap has grown, because it has not been enforced. When women are included in studies, researchers often don’t disaggregate the data, so health outcomes by sex and gender aren’t reported, according to a 2012 study by the Washington, D.C.-based Institute on Medicine. The scales remain tipped in men’s favor.

Because of the lack of female representation in drug studies, women’s intolerance of a medication or side effects from it may not be discovered until it hits the market. For instance, two decades after the sleep aid Ambien  was approved, it was found that it had been causing an increased risk for accidents the morning after taking the medication in women. The FDA’s response? Cut the woman’s dosage in half. Even drugs specifically for women are sometimes tested on mostly men. The  2015 trial for Addyi, a female version of Viagra, included 92 percent men.

THE FALLOUT FROM these systemic problems is far-reaching. Broadly, routine dismissal of pain has set a second-rate standard of care for women. After an orthopedic surgeon burned the median nerve at the brachial plexus during a surgery on my right shoulder, I endured months of relentless nerve pain, a sensation like being electrocuted. Several fingers were basically paralyzed. Before an out-of-state nerve surgeon confirmed I had a severe nerve injury, local healthcare providers had said my experience was no big deal. I was told that, rather than complain, I should be grateful I wasn’t dead, didn’t have cancer, and, because I couldn’t continue rock climbing, had avoided some future (hypothetical) climbing accident.

Other patients also reported developing a distrust of doctors. Marya Shegog is a Las Vegas-based public health expert who walks into doctors’ appointments like a military advisor prepped for the Situation Room. In graduate school, her cervical cancer diagnosis was delayed when she was gaslit by a white male gynecologist, a university department head. Shegog, who is Black, says, “To this day, I have a hard copy of all of my medical records, especially my OB-GYN records, that I take to every doctor.”

And she should. Minority women, especially Black women, suffer greater consequences and have worse health outcomes than white women. Black women are three times more likely to die from  pregnancy-related complications. And, while Black women are less likely to develop breast cancer, they are more likely to die from it.

In his book Masters of Health: Racial Science and Slavery in U.S. Medical Schools, UNLV professor of African American and African Diaspora Studies Christopher Willoughby writes, “As medicine created socially and culturally powerful institutions of education, physicians also embraced racist ideas about the nature of humanity and health.”

For example, a 2022 JAMA (Journal of the American Medical Association) study reported, “Physician implicit bias has been associated with false beliefs that Black patients have greater pain tolerance, thicker skin, and feel less pain than white patients.”

Victim-blaming may be the most pernicious effect of medical gaslighting. It can be seen in consumer articles instructing patients, “Know the signs of medical gaslighting!” and “Be your own advocate” placing the onus of fair treatment on patients who are in pain, rather than the institutions charged with their well-being. There are also assumptions of privilege in this ask — as if every patient has the knowledge, resources, and time to advocate on their own behalf.

For more than 20 years, medical researchers exploring gender bias have proposed another solution: See that medical schools integrate gender and sex differences into their curricula to address implicit bias.

“ACADEMIC MEDICINE, APART from being toxic, is racist, sexist, xenophobic, (and) elitist,” says Dr. Pedro “Joe” Greer, founding dean of Roseman University of Heath Sciences in Las Vegas. Roseman’s leadership is diverse — Greer is Latino — which is rare in medical academia. A 2019 study by the American Board of Family Medicine indicated that minorities accounted for 11 percent of deans, and women comprised 18 percent, in U.S. medical schools.

But that’s only part of the problem, according to Corrin Sullivan, assistant dean for curriculum at UNLV’s Kirk Kerkorian School of Medicine. “A lot of people, unfortunately, get confused that this might be a social justice issue instead of patient-centered care,” Sullivan says. The school’s founding dean, Barbara Atkinson, wanted to train clinicians and make them aware of implicit bias — so that they could be better doctors.