I'm a doctor who's witnessed medical gaslighting. Here's how I try to avoid it, and how patients can advocate for themselves.

• Patients are talking about having their symptoms dismissed.

• Systemic issues and the way clinicians are trained can lead to gas lighting.

• This is the perspective of Dr. Varshavski on why medical gaslighting occurs and how patients can address it.

An as-told-to essay was written based on a conversation with a doctor. It has been edited to make it clearer.

People don't like how the healthcare system works.

Patients feel providers put a lot of emphasis on being overweight while ignoring other symptoms.

Patients say doctors don't listen to their mental health concerns.

Patients with chronic pain feel that they aren't being treated fairly because doctors think they just want drugs.

I can see both sides of the equation in all of these cases.

I know that a lot of things can go wrong when a patient carries too much weight, but it doesn't mean that we don't have to look further.

There's not enough training that goes into mental health for all specialties, so a lack of attention on mental health is a systemic issue.

When it comes to pain, we have to make sure that we don't harm our patients by giving them something, but at the same time not keeping away medications from someone who actually needs it.

What appears to be gaslighting may be something else

I don't think there's a lot of doctors who gaslight patients. The system creates communication breakdowns that look like gas lighting situations.

Correct advice can be delivered in a non- patient friendly way.

It's outside of the doctor's control that they don't have enough time with the patient.

When a patient is talking to a doctor, they are trained to enter data on the computer, but that can leave a patient feeling unheard. It feels devaluing when you change a patient to a series of checks. That's not the provider's decision.

Good providers can fall victim to this point in the gas lighting conversation. Anyone can experience this.

Sometimes doctors are gaslighting and don't care about anything.

Doctors should take a team-based approach to treatment and diagnoses

To be as transparent as possible is the best way for providers to not fall prey to perceived gaslighting.

Sometimes, I have to be in the computer and check things off. I'll say to the patient, "For the first part of this visit, I really need to go through these check boxes." We'll get through this, but it will sound robotic. We can have a discussion.

Patients are very appreciative of that, but that's not something that's taught, and that's something that needs to be discovered or understood by a physician who does that.

One of the things providers should be doing is explaining their pathway and their reasoning as to why they're making a specific diagnosis, as well as why they think a certain treatment would work, because it needs to be a team-based approach.

There are a few diagnoses that I think are most probable and the treatment plan for each one. I asked the patient if they had any theories as to what was happening. Do you have any concerns about the condition?

They might come in with a cough, and I might think it's just a cold, and then explain why they don't need antibiotics.

They walk out without addressing their concern about cancer. I didn't address the heart of the patient's concern when I gave accurate diagnoses and treatment.

We as doctors are not good at teasing out.

Take advantage of the hospital's patient advocacy office    

It can be hard to advocate on your own when you're critically ill. If you call patient advocates, they will speak to the providers for you.

It's like getting a single employee to help you, and only for you, as if they had a fiduciary responsibility to you. I think it should be used more frequently.

Ask the nurse if you'd like the patient advocacy office and press zero.

People who have someone by their bedside will have better outcomes. Communication errors and medication errors will be less likely if you have a patient advocate with you.

Labeling something "gaslighting" can actually become a self-perpetuating prophecy 

It is important to study gas lighting systemically.

Falling down on the line of thinking thatdiagnosing is not important to the patient will hurt your relationship.

Cognitive behavioral therapy can be useful in establishing "charitable thinking" as a patient.

If you think you're not getting adequate care, you should assume that the reason is outside of the provider's control. I'm trying to get the most out of my visit.

It's very difficult to say "OK, I need to ask questions and make it clear to the provider that I still don't understand what's going."

You have to look for a second opinion if you're still shut down.

You get the best outcomes if both parties are charitable.

You can read the original article.