Medical Gaslighting and C Diff: Understanding the Patient Experience

When medical gaslighting happens to patients, it seriously impacts their lives and health care journey. Melissa Geraghty, PsyD, shed some light on this topic during a presentation at the 2023 National C. diff Advocacy Summit in Washington, DC. Medical gaslighting can cause varying psychological difficulties for patients and lead to long-term psychological damage. In turn, this can result in a lack of engagement with medical care and prescribed medical treatments.

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For many patients with Clostridioides difficile, the experience of medical gaslighting is a common one because many health care providers lack education and familiarity with the disease. This can lead to health care providers relying on assumptions and misconceptions about the disease when addressing a patient’s symptoms rather than looking to available facts and data.

“We hear about gaslighting a lot in family relationships, but there’s [also] this medical component,” Geraghty, a clinical health psychologist and CEO of Phoenix Rising, said during her presentation. “Medical gaslighting [not only occurs] with doctors and nurses, but it can [also] occur with family members, coworkers, and bosses—medical gaslighting is rampant.”

In general, gaslighting can be defined as someone intentionally manipulating another individual to the point where that individual questions their beliefs, reality, judgment, and memories. Additionally, gaslighting is a form of emotional abuse that can extend beyond the family into the medical setting.

Geraghty explained that there are 5 common gaslighting techniques:

• Countering: “You never remember things accurately,” or “You have a bad memory.”
• Withholding: “I don’t know what you are talking about.”
• Trivializing: “You are overreacting.”
• Denial: “I never said that.”
• Blocking/diverting: “Why are you so defensive?”

Geraghty noted that other common examples of gaslighting in the medical setting can include a patient being told that concerning symptoms they are experi-encing are “just anxiety” or are an “overexaggeration.”

“I remember when I started to become paralyzed from the waist down. I was told it was just anxiety. It turned out I had a rare disease of my spinal cord and needed neurosurgery,” Geraghty said.

There are also C diff–specific examples of medical gaslighting that are common for patients with this infection. C diff is a known health care–acquired infection (HAI) that is often brought on during a hospital stay or posthospital visit. Some C diff–specific medical gaslighting examples include:

• “Your symptoms are not that bad. You can just recover at home. I don’t need to prescribe you anything or do more tests.”
• “You just have the stomach flu.”
• “You are just having a bad irritable bowel syndrome flare-up—you’ll be fine.”
• “You should eat better and lose some weight. You’ll be healthier and things like this won’t happen.”
• "C diff isn’t serious. It’s rare for patients to be hospitalized for it, let alone diefrom it, even if it’s considered severe. Go home, drink some fluids, and take loperamide.”

“Of course, with medical gaslighting also comes medical trauma,” Geraghty said. “These are like a tag team.” Medical trauma can be defined as a set of psychological and physiological responses to pain, injury, serious illness, medical procedures, or frightening treatment experiences.

Geraghty noted that there are also specific signs that can help a patient identify whether they are experiencing a response to prior medical trauma and/or gaslighting. For example, common symptoms can include feeling as though you must plan extensively for each medical appointment, feeling uncomfortable or unsafe going to a doctor’s appointment alone, shutting down during a medical appointment and/or becoming emotionally numb or mentally exhausted after the appoint-ment, and mentally going through all the worst-case scenarios the doctor, nurse, or other staff may say or do in order to prepare a response before a medical appointment.

“More signs can include [starting] to question your own pain and the validity of your pain, wondering [whether] your symptoms really aren’t that bad, or thinking that maybe the doctor is right and you are just overexaggerating,” Geraghty said. “You might also avoid social media, TV, films, books, or environments that remind you of past medical trauma from past medical experiences in general. You may also feel physically ill or have increased anxiety before medical appointments, and this can continue to happen years after a person has had C diff.”

Geraghty explained that patients can look to manage these issues in the future, especially in instances of C diff recurrence, by finding a new doctor, bringing someone along to appointments, or writing down detailed notes of the experience during the medical appointment, if possible.“

You can also talk about your experiences with someone you trust, such as a therapist, family member, or friend,” Geraghty said. “What I found that can be very helpful for patients, especially as I see many complex patients—and am one myself—is that when a doctor refuses to run a test, ask for it to be noted in your chart. A lot of [patients] say that when they make this request, the doctor ends up doing the testing anyway because they don’t want to have to write in a chart that they refused to do a test.”

Another common example of medical gaslighting can include blaming a patient’s weight as the source of their C diff symptoms. “What some of my fat patients say—and yes, it’s OK to use the term fat—is that if doctors start to question weight as the source of the problem, the patient will ask...‘What would the treatment be if I were thin?’” Geraghty said. “My patients will say that—not with anger, but assertively.”

Geraghty noted that this assertive framing allows the patient to ask the doctor to put their weight to the side in order to discuss their C diff, which is an HAI that has not been found to be correlated with patient weight in data investigating the subject. “Just knowing your voice is important and your experience [of your health care] matters is incredibly valuable—and it’s OK to discuss that experi-ence with others,” Geraghty said. “This is the first time I’ve ever [spoken] about my experi-ence of C diff in a room with other C diff survivors, and I can tell you that I already feel like part of the family. It is all about using your voice and empowering yourself to assert your health care needs.”

Reference

Geraghty M. Medical Gaslighting & C Diff. Presented at: 2023 National C. diff Advocacy Summit; April 24, 2023; Washington, DC.