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In this episode, we speak with Karla Lester, a pediatrician and certified life and weight coach, about her experience with gaslighting in the workplace. Karla shares her story of encountering a hospital CEO who lied about outcomes and used gaslighting tactics to control the narrative and silence dissent. She discusses the three stages of gaslighting and how she ultimately made the difficult decision to resign from the hospital. Karla also shares insights on the impact of gaslighting in the workplace and how to recognize and address it. Tune in to hear Karla’s powerful story and learn about the importance of speaking up in the face of manipulation and abuse.

Karla Lester is a pediatrician, certified life and weight coach, and diplomate, American Board of Obesity Medicine. She is founder, IME Community, and can be reached on Twitter @DrKarlaA, TikTok, Instagram @ime_community, Facebook, and YouTube.

She shares her story and discusses her KevinMD article, “Surviving a manipulative CEO: my experience with gaslighting.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today, we welcome back Karla Lester. She is a pediatrician and a certified life and weight coach. Her recent KevinMD article is titled “Surviving a manipulative CEO: my experience with gaslighting.” Karla, welcome back to the show.

Karla Lester: Thanks for having me. Always appreciate it.

Kevin Pho: Now, for those who are interested in hearing Karla’s story, she’s been on many times. Go to KevinMD.com/podcast, upper right-hand corner, and search for Karla’s name to hear her story. But I want to get right into your most recent article, “Surviving a manipulative CEO: my experience with gaslighting.” How did this article and story come together?

Karla Lester: Well, it’s a long story, but I feel like I need to get it out. I almost had to do it for myself, to kind of purge this story, as my first article publishing on KevinMD.com. So thanks for the platform, as always. I’m grateful. I had to get it out.

What I experienced was three and a half years ago. I resigned, per my attorney’s directive, effective immediately, from my high-level job at a children’s hospital, after building a population health center that was founded on the resources that I built from scratch in my nonprofit, Teach a Kid to Fish. And what I experienced is, unfortunately, what so many physicians who advocate for patient safety and quality, and nurses, and anyone in health care, are experiencing as an epidemic, and that is toxic emotional abuse and gaslighting.

So it was extremely difficult, and it has been and continues to be difficult, for me to intentionally heal from what was the trauma of up to 20 individuals gaslighting me at different points as I spoke up for patients. I would do the same thing again, and endure that, to speak up for patients and the mission of the organization. So it’s been intentional healing, and I’ve wondered, how am I going to share this story?

What I’m finding is I’m getting more reach-outs from physicians at the same organization who are experiencing what I experienced, and I’m able to help them. But what I was recognizing is it’s the gaslighting. We can’t fix or solve these toxic and broken corporate health care systems, children’s hospitals or even corporate health care, which is sad. We cannot fix and solve them. But if we can stay out of the Gaslight Tango and not engage, my hope is that I can help other physicians who are suffering and are victims of gaslighting recognize gaslighting and gain some clarity, so that they can better determine, more readily than I did, their next step, whether it’s to get out, move on, or find who they can align with who can actually help them if they’re experiencing this.

Kevin Pho: Now, for those who didn’t get a chance to read your article yet, give us a few anecdotes or stories that really highlighted that gaslighting experience.

Karla Lester: Well, first of all, I read the book The Gaslight Effect by Dr. Robin Stern, who I noticed you had on your podcast recently talking about gaslighting, so I hope everyone will listen to that podcast and read her article.

So I talked about the king, the president and CEO, because the culture is set at the top. I didn’t know his past history, where he was at a former children’s hospital, but I noticed when he came, he came at the same time I was launching the center, the population health center that I was leading. He was touted to be this really amazing global leader. I met with him, and I was like, “Oh, wow.” I’m drinking the Kool-Aid here. This is an exciting time for expansion. We need this.

And I noticed right away that he lied a lot. As an example of that, he would say, “Oh, we have these strategic partnerships for research,” and I knew that that wasn’t the case. But in order to recruit faculty, and his wife was hired as the faculty recruiter, I was in small meetings with him a lot, because I was the community outward, community health for the hospital, and the face of it, like the front porch is what we called me and our center. So I was in a lot of meetings. [Remark removed by the editor.] Not only is she an amazing faculty recruiter. So to recruit faculty to do research, what do you need? This really powerful infrastructure, operationally, between the medical center or whatever. I’m not going to go into that. But I knew that that wasn’t the case.

But then he started lying about different outcomes, saying that we’re affecting infant mortality rates, and that was a real problem in the area, in the community. Of course we want to do that, and we want to resource it, but when you just lie about it and make up outcomes. So my thing was, I’m uncomfortable with that. I would like to put resources into that issue. I’d like to actually be able to say that for real and have that be a truth, but we’re not going to get anywhere if he makes it up. So then I was told, “Well, what are you going to do about it?” Because I’m like, “He just lies.”

And then there was a meeting, and how it affected me, and I started to get retaliated against, because you don’t speak up against the king. It was at a community physician meeting in my community, and they were looking to expand. Physicians came, and he was speaking and presenting outcomes. For the clinic that I had created with Children’s, the weight management clinic that I had led, it took me three years, and my nonprofit resourced all the community programs. He said that we have better-than-national outcomes for our patients, which is, one, untrue. But we had some really exciting collaborations with the university, looking at program data and looking at ACEs, social determinants of health, and quality-of-life measurements, not just BMI. We were really getting somewhere.

Unfortunately, after I said, “Hey, that’s not true,” I just assumed he was misinformed, that a marketing person put the slides together and he just read them all. So I’m giving him the benefit of the doubt. I’m sticking up for him. And then I said, “What we have that is even more exciting is the opportunity for NIH grants and collaborations, and to really measure outcomes.” And then I get a calendar invite regarding HEROES from the vice president of pediatrics, who’s not a physician.

It ended up being that that meeting was canceled, but they started to retaliate. They cut the agreement with the university. We were providing behavioral supports with them, with PhD students as the behavioral supports. The more I spoke up and said, “We need to build the capacity; the patients are complex,” I got pushed out. There were meetings I wasn’t involved in, and I was told I was going to be replaced with an untrained nurse practitioner, which, of course, I was not OK with. And then they said, “We’re just filling you in. We expect you to be supportive.”

So the irony is I’m at this hospital, I’m leading the center, I’m spending a day a week in the clinic, wanting to expand it and lead it to a higher level, which is what I got hired to do. And then it was just this confusing gaslighting, and they said, “We expect you to be supportive.” They didn’t allow me to interview the new nurse practitioner who they were replacing me with in this community where I am and where I had my nonprofit. So I said, “That’ll be my last day.” I don’t agree with that level.

So then everything unraveled at the hospital. There were bigger issues, a lot of surgeons left, and everything was kind of unraveling for the king. Then they continued to gaslight me, and then they threatened that, as the surgeons left and people left, they were going to close down that clinic, that HEROES clinic in Lincoln.

Anyway, that’s where I took the article: the stages of gaslighting. Stage one is disbelief, where they say something and you’re just kind of shocked and confused. Stage two is when you get defensive. Of course you’re going to defend yourself, which I want doctors to recognize if they’re being gaslighted, and then stay out of it. And then stage three is depression.

So I talked about my last meeting I had with the king, and how that was just a really scary meeting, almost out of the movie Gaslight, starring Ingrid Bergman. I had never heard the term gaslighting. I had never watched the movie. I had no clue that this was gaslighting. So I was meeting with him, and people said, “You need to meet with him, you need to meet with him,” not recognizing it was a setup. I drive the hour to meet with the king. My family and I were going to Europe the next day, and I had done enough coaching to where I decided to show up just supportive: I will see patients in the two communities, in Omaha and Lincoln, to keep the clinics open. It’s really important.

And it was just so chilling. All the people who were supposed to be at the meeting bowed out at the last minute: “Oh, I’m sorry, I can’t make it.” “Oh, I’m sorry.” It was just me and the king in his big office, and him like, “Why do you care? Why do you care about HEROES, Karla? And I heard that it’s just a personality issue.” They try to blame it on that, and it’s your fault, it’s your behavior. It was just this strange thing.

So I was like, this is going south, in my head, and I’m here again to support: “I will see patients. Let me know what you need.” Which really ticked him off, because he said, “We’re bringing a top-notch surgeon in who’s going to lead all the childhood obesity efforts.” What are you talking about? It’s the most important issue, as they cut all the programs that were supporting it.

So anyway, it’s a long story, but in that meeting I was able to just show up for the mission, which I will always do, even outside of the organization, and I can do more. But I was proud of myself. And he said, “Well, I’m not going to micromanage this.” When I left there, I was shaken up, and I had to drive the hour back to Lincoln. I remember calling my husband and saying, “I’ll never meet with him again.” And I called a member of the board, who was a part of the gaslighting. I didn’t realize that at the time, but they were a big part of it. And I said, “I’ll never meet with him again. That was a terrible meeting.” And I sent an email to everybody, and I’m really glad I did, and I said, “That was a terrible meeting. He doesn’t get it. I’m never meeting with him again.”

So then we went to Europe, and a few days later we got the email, because things started to unravel, and the board just came to a head. All of the things that he had done at the former place and that he had done here, and they recognized this huge liability issue, I’m assuming. So anyway, there was a notification he was retiring within a month. So I felt victorious.

Kevin Pho: So you mentioned that it wasn’t just you. A lot of the surgeons had also left. What was the feeling among the clinical staff as a whole? Did they feel as a group they were being gaslit? What was the environment like at that hospital?

Karla Lester: Like Lord of the Flies. We didn’t know all of the things. It wasn’t like, I mean, I do know the surgeons there, and I’m not going to speak for them. I know some inside information, of course, but everyone who left or resigned was speaking up for patient safety. And I wouldn’t say that there was any opportunity for us to be together and decide, and say, “Oh, we’re being gaslit,” or some sort of a common approach to it. I don’t think they had any clue what I was specifically going through.

Kevin Pho: Now, was the CEO’s entire staff part of that gaslighting, to kind of maintain that environment, or was it just him?

Karla Lester: Of those 20 individuals, 14 are gone, so six are there. I think four will, who knows, but I just can’t imagine that four of them, just for many reasons, will hopefully be gone. And the sad thing is that’s just the milieu. That’s the environment that’s there.

So how I decided to approach it is, I’m a writer. I write all these articles. My whole career has been addressing childhood obesity, so I’m writing a book about that, and that’s what I do for my work, and it’s my passion to help children and teens. But also, this has been a calling and a purpose that’s been put on me. So how I’ve decided to do it is to approach it in the way of really helping physicians to recognize gaslighting, and then go through each of the 20 characters who were involved in it. I haven’t decided who’s up next, but I may write another article.

So there are different levels. There’s the toxicity that’s at the top and sets the culture; culture is set at the top. Whether that person is a narcissist, I’m pathologizing, or even worse, I think, in our case here. And then there’s this level of shape-shifters, people who want to keep their jobs. They were just saying, like, who’s loyal to this king? Who’s going to show up and be willing to make up outcomes to suit the target audience, be willing to control the narrative, be willing to silence anyone who speaks up? Those are the three strategies that he employed, and those are the strategies that everyone who was a part of that emotional abuse of physicians and gaslighting was willing to employ as well. So they’re rewarded, and some of them are even promoted to higher positions.

Kevin Pho: So let’s talk more about that. This story is not uncommon to a lot of hospital systems. I’ve read many, many stories about physicians being gaslit. So what are some signs and red flags that they should be aware of?

Karla Lester: If somebody calls you to a meeting, you want to make sure that you’re not going to be alone. And if you are, you can ask them to record it, or bow out of it. Make up an excuse: “Oh, I’m sorry, I just got a text.” And then you want to document everything.

First of all, recognize when they do the U-turn and they start to create some self-doubt within you, or some confusion. Like, I kept thinking, “Oh, I just need five minutes and I can fix this,” and that they didn’t have clarity. Don’t believe that they’re going to arrive at some value or some level of ethics that you ascribe to. That’s not going to happen. So you’re not going to fix and solve anything.

So decide ahead of time. If you’re going to meet with somebody, decide ahead of time, “I’m showing up for the mission. I’m showing up to support patient safety and quality,” and have that in your head the entire time you’re meeting with them. And then, for me, what really helped me was I didn’t defend myself. When he said, “Oh, I’ve heard from so-and-so and so-and-so that this is a personality issue, and that you’re emotional, and it’s your behavior,” I said, “Everyone’s entitled to their own opinion about me,” and just sat there kind of with a smile on my face. And I said again, “I’m here to support the clinics. I’m willing to see patients. I’m willing to do whatever it’s going to take,” which pissed him off.

So anyway, don’t engage. Don’t engage in the Gaslight Tango, because it requires a gaslighter and a gaslightee. It’s just like bullying when I’m coaching teens. I mean, these people are bullies, narcissists, whatever. We don’t have to pathologize them or do a DSM-5 diagnosis, but what we can do is have an understanding that we’re not going to be there to fix and solve, and that we’re not stuck in it. So bring some clarity. When they turn it on you, don’t fall for it. Don’t defend yourself. Don’t convince them of anything, because that’s a waste of your time.

Kevin Pho: Now, when you say that you should bring someone along with you to the meeting, are we talking about a colleague, or are you talking about an attorney? What do you mean by that?

Karla Lester: Well, if you bring an attorney, you’re going to be screwed. I mean, they’re going to really try to get you. So I would say definitely bring a colleague, maybe from your department. Oftentimes, unfortunately, HR isn’t helpful. If you reach out to HR, that could backfire. It did against me. The vice president of human resources at the time was definitely a part of the gaslighting tactics: “Oh, I’ve never heard of anything like this happening at Children’s. I’ll get back with you.” They never did. So I say somebody from your department who is a like-level colleague, and you want to document everything.

I had amazing attorneys who guided me along the way, and they are used to working with physicians, and they’re top employment attorneys. It’s worth having those conversations behind the scenes, which I did have with them along the way, and they would say, “Karla, why don’t you leave now?” So they tried to get me out, sure, well before I left. And then it came to such a head, they were like, “What is keeping you here?” It was like Sunday night at 10:30 p.m., and they’re like, “We’re getting you out of there tonight,” because it really got to a point where we were all concerned about my physical safety.

Kevin Pho: Now, once a physician realizes that they’re being gaslit, what’s their immediate next step?

Karla Lester: Take a pause, OK? I want to say, like, “This is gaslighting.” Use the word. Call it gaslighting. That is going to be just so powerful in your mind: I’m being gaslighted. There’s nothing wrong with you that that’s happening to you. You don’t cause it, and you don’t control it. You can say to yourself, “I don’t have to be stuck in this. I don’t have to fix this. I’m not going to solve this.”

And so then I think getting some outside support, and also owning your truth. You know your truth. You may want to write it down. I mean, the main thing is we think we have to fix and solve these things, and I want physicians to recognize that you’re not going to fix a toxic system. So don’t go, like I did, over here and over here and talk to this person. There’s so much self-doubt and confusion. It’s like, is this real? Is this, you know? So don’t do that. Own your truth.

Kevin Pho: At what point should one consider getting outside help, like legal help? At what point did you decide that “this is more than I can handle, I need help from an attorney”?

Karla Lester: Well, if they’re asking you to meet alone, they’re asking you to go to meetings, and you kind of see the writing on the wall, I would especially do that. I think anyone in health care these days, anyone who speaks up, whether you’re a physician, a nurse, or anyone in health care, if you speak up and you are correct about a patient safety issue or quality issue, you’re going to be retaliated against, and you’re going to be gaslighted. There are so many people in corporate health care who have positions that they should not have, and they know that they’re imposters. So if you are someone who is a threat because you do have the skills and you are doing a wonderful job within that department, you’re going to be retaliated against, and you’re going to be gaslighted. So just recognize that that’s probably going to happen.

So if at the moment you have any sort of concern about patient safety, and you’re needing to speak up, and you need to, and you have it documented, you need to find a good employment attorney who works with physicians. I had one involved with me all along. As we moved my nonprofit Teach a Kid to Fish’s assets over to create the center that I led, there were so many red flags with that process, and so much gaslighting that started then, that my attorney had to be involved, literally from the start. So for years, my attorneys were involved.

Kevin Pho: We’re talking to Karla Lester. She’s a pediatrician and a certified life and weight coach. Her KevinMD article is “Surviving a manipulative CEO: my experience with gaslighting.” Karla, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Karla Lester: Well, first of all, my whole heart is with you if you are a physician or a nurse experiencing gaslighting and toxic narcissistic emotional abuse in health care. You are not alone. You are not broken. You are wholly good, OK? You can recognize gaslighting. You can get out of the tango. You don’t have to continue to be a victim. Please don’t try to fix or solve something that’s so toxic and broken that you can’t. Please create a pause. Recognize gaslighting, name it, and get the supports you need so that you can have clarity to determine what will be the next best step in your career, whether that’s intentionally healing from the gaslighting and then moving forward, finding a niche within where you are that you can work in and show up for patients and the mission of the organization, or whether you need to do something different. You’re not stuck.

Kevin Pho: Karla, thanks again for coming back on the show and sharing your story, time, and insight.

Karla Lester: Thank you.