An excerpt from Story Treasures: Medical Essays and Insights in the Narrative Tradition.
The Gish gallop – named after American creationist Duane Gish, who challenged the science of evolution – is a rhetorical technique often used by a debater to throw out a fast string of lies, non-sequiturs, and specious arguments, so many that it is impossible to fact-check or rebut them in the amount of time it took to say them (think: Donald Trump). Trying to figure out how to respond makes the person look confused because they don’t know where to start grappling with the flood of lies that has just hit them.
It is a form of gaslighting.
The term “gaslight” originates from the 1938 play Gas Light, written by British playwright Patrick Hamilton. The play was later adapted into a successful 1944 film starring Ingrid Bergman and Charles Boyer.
In the story, a husband manipulates his wife into thinking she is going insane by gradually dimming the gaslights in their home and then denying that the lights are changing, among other deceptive tactics. This psychological manipulation leads the wife to doubt her own perceptions and sanity.
Gaslighting is real and widespread in medicine. According to the October 2022 SHE Media Medical Gaslighting survey, 72% of women experienced medical gaslighting. In addition to women, other vulnerable groups include people of color, members of the LGBTQ+ community, and older adults. Gaslighting makes patients seem or feel unstable, irrational, and not credible. It makes them question themselves and their experience utilizing an imbalance of power between practitioner and patient.
Unfortunately, medicine is full of that imbalance of power—in knowledge, time, and physicality. One is an all-knowing doctor (or advanced practice provider); the other is a layperson. The patient is in a gown; the doctor wears a white coat or is dressed business casual. There is a time imbalance in which patients live with their conditions, sometimes for years, yet health care workers must squeeze in a whole discussion of that condition in 10 or 15 minutes.
All of those imbalances are so powerful that they can even overcome a health care professional’s knowledge and judgment when the health care professional is a patient. Many doctors and nurses who have experienced health care from the “other side” have written about being gaslit. Overwhelmed by the force of another health care professional, they come to doubt themselves and fail to trust in their own experience, which causes them to question themselves and their sanity. Just imagine how the experience of being gaslit feels for routine patients if it can feel that bad for people who work in the health care system.
Patients can be gaslit in various ways, such as dismissing or minimizing symptoms by attributing them to psychological causes without thorough investigation, contradicting a patient’s account of their symptoms or medical history without evidence, or ignoring and belittling a patient’s concerns or questions. These actions can deeply affect patients, leading to increased anxiety, depression, feelings of helplessness, and a significant erosion of trust in health care providers and the health care system as a whole. Moreover, it can result in delays in diagnosis and treatment, further compromising patient health outcomes.
Several factors apart from a power imbalance can contribute to the occurrence of gaslighting in medical practice. Implicit biases related to gender, race, age, or mental health can lead to dismissive attitudes towards certain groups of patients. Communication issues, including poor interpersonal skills and a lack of empathy, can also result in misunderstandings and dismissive behavior.
Addressing gaslighting requires increasing awareness among health care providers about the signs and impacts of their behavior. Correcting the underlying factors is crucial in preventing and mitigating gaslighting. This means training practitioners in empathy, active listening, and cultural competence, emphasizing a patient-centered approach that validates patient experiences and involves them in decision-making. Health care providers have an ethical duty to respect patient autonomy, provide truthful information, and avoid harm. Adherence to professional standards and guidelines that promote respectful and evidence-based patient interactions is essential.
Patients who feel as though they have been gaslit by health care providers can employ various strategies to advocate for themselves and ensure they receive appropriate care. One effective approach is to document everything meticulously. Keeping detailed records of medical interactions, including symptoms, dates, times, and specifics of conversations with health care providers, can provide a clear timeline and serve as evidence if needed.
Seeking a second opinion is another crucial strategy. Patients should feel empowered to consult another health care provider if their concerns are not being taken seriously. A fresh perspective can validate their experiences and provide new insights. Additionally, bringing a trusted friend or family member to appointments can offer emotional support and another perspective on the conversation. This person can help take notes and advocate on the patient’s behalf.
Clear and assertive communication is essential. Patients should express their concerns and symptoms without minimizing them, using “I” statements to convey their feelings without sounding accusatory. Asking detailed questions about diagnoses, treatment options, and the reasoning behind medical decisions can help patients gain a better understanding and feel more involved in their care. Requesting written summaries of visits, including diagnoses, treatment plans, and follow-up steps, can also ensure clarity and provide a reference for future appointments.
Utilizing patient advocates or ombudsmen can assist in resolving concerns about care. These professionals can help navigate the health care system and mediate between patients and providers. Additionally, educating themselves about their symptoms and potential conditions can empower patients to ask more pointed questions and feel more confident in their interactions with health care providers.
If gaslighting persists, patients should consider reporting their concerns to the health care facility’s administration or relevant regulatory bodies. Formal complaints can sometimes prompt necessary changes and accountability. Seeking emotional support from mental health professionals, such as therapists or counselors, can help patients process their experiences and build resilience. Patients who have been severely affected by gaslighting may require trauma-informed psychotherapy.
Connecting with others who have had similar experiences through support groups can provide validation, advice, and encouragement. These groups can be found online or through local community organizations. Finally, if a patient constantly feels gaslit by a particular provider, it may be beneficial to switch to a different practitioner or practice. Finding a provider who listens and respects their concerns is crucial for effective care.
In conclusion, gaslighting in medical practice is a serious issue that undermines patient trust and can lead to adverse health outcomes. By fostering a culture of empathy, respect, and patient-centered care, health care providers can reduce the risks of gaslighting and improve the overall patient experience. Patients should not persist with providers who engage in gaslighting; they should be equipped with strategies to counteract it.
Debaters are instructed to call out the Gish gallop by name, identifying their opponent and saying to the audience: “This is a strategy called the ‘Gish Gallop’ – do not be fooled by the flood of nonsense you have just heard.” This declaration casts doubt on their opponent’s debating ability for an audience unfamiliar with the technique, especially if no independent verification is involved or if the audience has limited knowledge of the topics.
Taking affirmative action in one form or another is often the best way to deal with experiences that are consistently dismissed by the people who make you feel crazy.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Story Treasures: Medical Essays and Insights in the Narrative Tradition.
