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We sit down with Tracey O’Connell, a radiologist and physician coach, to explore the pervasive issue of medical gaslighting within the health care industry. Tracey shares her own experiences and insights, shedding light on how this phenomenon impacts both medical professionals and patients.

Tracey O’Connell is a radiologist and physician coach.

She discusses the KevinMD article, “Medical professional gaslighting: the lack of psychological safety in medicine.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Tracey O’Connell. She’s a radiologist and physician coach. Today’s KevinMD article is “Medical professional gaslighting: the lack of psychological safety in medicine.” Tracey, welcome back to the show.

Tracey O’Connell: Thanks, Kevin. Happy New Year, good to see you.

Kevin Pho: Happy New Year to you as well. Now go to KevinMD.com/podcast, you can search up Tracey’s name to see her prior episodes and her story. But today let’s jump right into her most recent article about medical professional gaslighting. So tell us about this article for those who didn’t get a chance to read it.

Tracey O’Connell: Sure. In all of my prior articles that I’ve written with KevinMD, it’s usually been something about a personal story of my own and then reflecting upon, where did I go wrong, where did I feel like the system went wrong with me, where was the heartache, where was the solution, where’s the anger, how do we deal with it?

And I realized at some point last year that some of these stories that I’d been telling myself, the way that I’ve been phrasing my own experiences, was putting a lot of blame on others and blame on myself. And I really wanted to delve into, why was I having this kind of struggle, why was I having this reckoning with things that may have happened decades ago, and what were those stories meaning to me now, and what did I want them to mean for future generations of doctors and my colleagues? I typically write because something’s inspired me or something’s haunted me.

And this idea of gaslighting, I think it was word of the year a few years ago, and in the zeitgeist it’s often referred to in romantic relationships, intimate relationships, maybe within families. And Robin Stern wrote the book The Gaslight Effect and talked about there being this Gaslight Tango, where you have the gaslighter who needs to be right at all costs, and the gaslightee who needs to have the approval of the gaslighter at all costs. And here is gaslighting defined in a way that kind of made me wake up to, have we all been experiencing gaslighting in some way?

And so I did a Google search, and the majority of things when you look up medical gaslighting have to do with patients feeling gaslighted by their health care practitioner, being felt like they were crazy, weren’t listened to, hysterical, and the patient left feeling unheard, unseen, and not validated in their feelings.

And I started thinking about when I tried to look up, what is this phenomenon called among medical professionals? I can get pretty granular with this, but overarching is this sort of universal understanding that medical culture presumes that they must be right at all costs. And whether we’re in training, or whether we’re practicing now, or whether we’re competing with a group across town, or trying to get an academic promotion, whatever it is, there’s always this idea of needing the approval of somebody else. And maybe it’s the approval of a patient, maybe it’s the approval of the medical system. In training it’s the medical student needing the approval of everyone above them. Once you’re even an attending, you’re seeking the approval of the dean, or maybe the head of the hospital. And even the head of the hospital is seeking the approval of the shareholders. And this hierarchy that we have in medical culture keeps people psychologically unsafe.

Kevin Pho: So you mentioned Robin Stern. I had her on a podcast and I know exactly what her definitions were and how they have resonated with a lot of medical professionals. So tell us an experience from your past now that you may have felt gaslit. Share a story of something that happened in your past now that you’ve reflected on it.

Tracey O’Connell: I have so many stories. And the funny thing is that even in response to this article that I wrote, there have been people responding to the article saying, what you’re describing is not gaslighting, which then of course feels very gaslighting. Because again, gaslighting is this idea of questioning what someone thinks and what they believe, and so we’re constantly questioning what we believe.

And the way to gaslight someone, it’s very easy, whether you’re a patient or a practitioner, it’s anyone planting a seed of doubt. And then you wonder, because we’re inundated with so much information and we’re always behind, and we always maybe haven’t kept up with the latest journal articles, and someone might say, oh, I can’t believe you’re not prescribing this for this malady. And then you question, gosh, am I a loser, do I not understand my work, am I a fraud? All these ideas that we toss around a lot, impostor syndrome, burnout, a lot of these things I believe are the consequences of the way that we speak to ourselves in this conditioned belief that happened even before our frontal lobes were formed, right, if we entered medical school right out of college, let’s say.

So for me, I would say I have so many examples, but ones that are coming to mind in this moment would be, I remember in first year of medical school the anatomy professor said, there are two types of students who will get honors, those who work their asses off and those who are just naturally gifted. And I remember the understanding was that you will get honors, and you should want to get honors, and if you don’t get honors then you won’t make it.

Now, people hear what I’m saying today and hear what others say through the lens of their own lived experiences. So for me, I admit to being a highly sensitive person and also an idealist, and so those are qualities that make a great doctor, but they’re also qualities that make one susceptible to gaslighting, in the sense of, do I have confidence in myself, in my knowledge base, enough that I will not believe someone else’s interpretation over my own, that I will trust myself no matter what someone else says about me?

And so throughout my career, I went into radiology ironically to sort of protect myself from some of the emotional tolls that clinical practice takes, but it didn’t work, because I’m again a highly sensitive person and I’m trying to do good work. In radiology, for example, it’s the constant sense of, you’re not fast enough, you’re not smart enough, your differential isn’t correct, you didn’t interpret that study correctly, your reports are too long, your reports are too short, you didn’t include the latest technology offering in what we’re doing now. Even competition mostly among colleagues, coming from things like, I don’t know, your reports just aren’t right. They’re not right. Well, what’s wrong with them? Well, you should know. Comments like that.

And ironically for me it was never really from referrers or from patients, it was from my own colleagues, of questioning things like, well, this doesn’t sound correct, it’s not torn. I read a lot of musculoskeletal imaging. The meniscus is not torn. You could go down the hallway and get seven different opinions. And same with going to the orthopedists. You could go to an orthopedist and get seven different opinions about what should be done next. Operate, conservative therapy. Some would say, don’t say this in your report. Others would say, whatever you do, please say this in the report. The inconsistencies make you feel crazy. And because we don’t get that education in emotional intelligence and inner strength, we’re really susceptible to doubting ourselves, and that constant not-enoughness, that’s really the voice of shame.

So those are some examples. I have a lot more. But even in the example I wrote about in the article, I had, as a third-year medical student, my psychiatry rotation was remote. I was newly married, I had to stay away from home with a roommate that I didn’t know. I was already feeling very confused, the end of my third year, what am I going to go into, I don’t really like any of the areas that I’ve rotated through. And I was having trouble sleeping, and so I went to student health and was given hydroxyzine, Vistaril, for sleep, but they didn’t tell me that it had a really long half-life.

And so I went to this rotation, and a lot of the things I saw, and I wrote about in the article, really disturbing things, in the most extreme of the mental health spectrum, of patients who were catatonic or had tardive dyskinesia, or were children wearing helmets and drooling. Not really any time to discuss, nobody asking, how are you doing, how’s this impacting you, 23-year-old person. And it was affecting me a lot, and I wasn’t sleeping, and I was taking this medicine.

And then at the end of the rotation I was with a practitioner who was in an ER psych unit, and someone would come in and share a story for five minutes, and the psychiatrist would say, well, this is a bipolar, black and white thinker. And I would say, well, did you hear what just happened to them? And it would be, well, no, we have to move on to the next thing, this is just labeling, that crazy person.

And if I offered the patient a tissue, the attending told me that by offering them a tissue I was implying that I wanted them to stop crying, that I was shutting down their emotions by offering them a tissue. So these are just things where you think, my intuition is wrong, my intuition is wrong, to offer a tissue is not the right thing. I thought it was being a considerate thing.

And at the end of the rotation, because I kind of nodded off sometimes in the one-on-one interviews with patients, when we weren’t allowed to talk, right, we were observing, he told me as I was walking out the door, hey, you’re a great person, good luck to you, you have a sleeping disorder. And I didn’t sleep for a week.

And so by the classic definitions that could be construed as medical gaslighting, because I was given a diagnosis that wasn’t accurate of what the situation was. However, I wasn’t there as a patient and I wasn’t asking for a diagnosis. And also I ended up feeling crazy and not sleeping for a week and coming back after spring break and thinking that I was significantly mentally ill, and really having no safe place to do that.

And so that’s what I’m trying to bring attention to. This was the first article, and maybe of many that will follow, to talk about this medical professional gaslighting, how we speak to and interact with one another in this culture that is really founded on maintaining the hierarchy, not making a mistake and covering it up if you do, and don’t show any kind of weakness.

And I don’t believe that the gaslighting that occurs is intentional. I’ve had other people ask me, well, what you’re describing is not gaslighting because it’s not intentional. I don’t think it has to be intentional. I think it’s actually learned. I think it’s a learned coping mechanism to protect ourselves, like we would in the wild if it’s a dog-eat-dog world, of, I have to posture, I have to maintain my power, I have to make others question their own authority in order to maintain my sense of authority in the system.

Kevin Pho: Sure. You mentioned a term earlier, emotional intelligence, as a way perhaps to process gaslighting. How can physicians develop that emotional intelligence?

Tracey O’Connell: Well, I’m so glad you asked that question, because I think that most of us don’t learn it as children. Certainly it’s in the zeitgeist now, people are talking about this phenomenon, this concept of emotional intelligence was not something that any of us grew up learning about. It may have been demonstrated to us by our parents, of asking about our feelings, how we’re coping, not minimizing sadness or anger. The unattractive or unpleasant emotions would have been allowed and heard and acknowledged and repaired, and then allowed to go on with self-confidence, like, my feelings aren’t too big for other people to manage, my feelings are real and I can cope with them and I can be OK and move on.

So most of us are not likely, even though my understanding is a lot of medical training programs now are incorporating some of these concepts. I am most concerned, I think, about the people of my generation who are still practicing, who are parenting, who may be reparenting themselves and parenting their children in different ways than they were parented. There may be a lag in people having those skills. But certainly those formerly soft skills are now considered more valid and have more scientific backing. I think that a lot of research has gone into proving that even medical success is 80 percent emotional intelligence and 20 percent proficiency. So there’s rumors going around that are legitimizing emotional intelligence.

But I really think it’s critical to be taught to medical practitioners. I mean, in a way it’s more important than anything else we learn, because in this age of everything being digital and available, as a radiologist I don’t need to memorize the differential for a posterior fossa mass, I can just look it up. And the same way that, unfortunately, so much of our work is taken away from us now with computers and with demands on us that are not even intellectual, right?

But I do think that it’s almost like we should be selecting for people to come into medical life who somehow, we select for those who do have intelligence in ways that, it’s going to be tricky to measure, not like an IQ test or a board exam. It’s going to be some kind of empathy skills, or some kind of, even the way that we mandate you taking organic chemistry, there may need to be some kind of hoops to jump through to prove that you’ve got enough training to maintain compassion, maintain self-compassion, maintain the ability to trust oneself.

I think that’s kind of the whole thing, is we just don’t, we’re never taught to trust ourselves. We’re taught to put our faith in the medical professionals around us. But my sense, looking through the retrospectoscope, and also all the conversations I have with people that I coach or that I work with, is that these kinds of experiences, you have to experience them to recognize them and to know what psychological safety is. And I think, how do we create psychological safety in the system as it is now, where anything but perfection is not tolerated?

Kevin Pho: We’re talking to Tracey O’Connell. She’s a radiologist and a physician coach. Today’s KevinMD article is “Medical professional gaslighting: the lack of psychological safety in medicine.” Tracey, let’s end with some of your take-home messages to the KevinMD audience.

Tracey O’Connell: Well, I’d want to just keep the idea in there and plant the seed of what medical professional gaslighting is. Because if you think that you’re crazy, or if you’re lacking in confidence, I think that’s often what people come to me for, is, see, I’m lacking in confidence, I have all these accolades and I still don’t feel like I’m enough. Chances are it’s because you’ve been led to believe that you should doubt yourself and put your confidence and faith into something outside of you, which never is satisfied.

So psychological safety is an inside job, but it’s also something that we need to foster and be able to understand and model for others. So things like, if you feel like we select often for people who are more rational than emotional, maybe we need to review that and consider selecting for other reasons, being more collaborative and less seeking approval in the hierarchy, and more seeking comfort with self.

I think this day and age a lot of people are leaving because they’re no longer tolerating the dissonance between who they really are and the idea that if you’re burned out, the issue must be with them rather than the system. Or people feeling just spent and distraught and disillusioned and disenchanted with medical life.

And I want to leave them with a positive note, that rather than seeing the system, like I did for so long, as malicious and malevolent, I think that there’s very simple things going on, which is just the sense of competition and not-enoughness. And that there’s real value in figuring out those inner strengths before you go into the arena of trying to outdo other people. And then once in practice, to be able to never lose that self-trust, and to seek reassurance from others but also find reassurance in yourself and what you truly believe.

And to recognize that there’s medical professional gaslighting going on everywhere. I mean, we could talk about it for days, Kevin, because I think that it’s so much in the air we breathe and the water we swim in that we don’t see that it’s happening. But if you’re feeling psychologically unsafe at work, in my belief that’s because gaslighting is happening, because somebody needs to be right, you need to please someone who’s right, you need the approval of someone that maybe you don’t respect or don’t believe in, but you need them to approve of you in order to excel or advance or survive at work. And that’s an unpleasant and uncomfortable place to be in.

So I’m hoping to foster more dialogue. I’d love to hear from people. I’m collecting stories, I’ve collected a lot of them, of people’s own experiences. I’d also love to have a salon where people could discuss, like, is this gaslighting, is it not? The semantics don’t matter as much to me as the concept of addressing the lack of psychological safety in the culture that we’re all immersed in.

Kevin Pho: Tracey, thank you so much for sharing your story, time, and insight, and thanks again for coming back on the show.

Tracey O’Connell: Thank you for having me, Kevin, and for all that you do.