What to Say When Your Doctor Gaslights You

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Physicians can sometimes make you feel like you are completely ignorant and put you down, telling you that what you are feeling is because you are anxious and that they, who have studied medicine for many years, are the only ones who know everything about your body. Often physicians are right, but occasionally, they are wrong. Wrongly dismissing what patients are feeling is called medical gaslighting.

So, what can you do if you are really concerned about your physical health and your physician gaslights you? How can you push back and get your concerns addressed?

Here's a case scenario:

Jessica (real case but not her real name), a 57-year-old flight attendant, was in the shower when she felt something she had never felt before: a small mass in her right breast. Alarmed, she called her physician, who reassured her over the phone, saying that what she felt was probably nothing because her last mammogram, only four months prior, was completely normal.

Yet, Jessica made an appointment with her physician, who examined her in ten seconds, told her there was nothing abnormal, and added: "Stop touching your breasts! You shouldn't examine yourself because you don't know how to do it! You should leave this to medical professionals who are trained for that. You had a normal mammogram four months ago, so everything is fine! You're too anxious, and everything is in your head! Come back in 6 months, and I'll examine you again. Until then, goodbye."

Jessica felt embarrassed and ashamed, so she did what her know-it-all doctor said; she stopped examining her breasts and came back six months later. At that time, a very large, aggressive breast cancer was found in her right breast. It had already spread to several lymph nodes, and she had to have surgery, radiation therapy, and heavy chemotherapy. She remained cancer-free for three years; then her cancer came back, and she ultimately died from metastatic breast cancer.

What Jessica had felt in the shower when she called her physician the first time was the beginning of an aggressive breast cancer. She was rightly alarmed, but she was gaslighted by her physician, who made her feel inadequate, uneducated, and wrong when, in reality, it was her know-it-all physician who was wrong. Had Jessica's cancer been diagnosed and treated six months prior, when the mass was still small and not metastasized yet, the prognosis could have been much better.

What should Jessica have said to her physician when she saw her physician the first time?

How to talk to a physician who is gaslighting you:

• First, Jessica should have acknowledged that she heard, understood, and respected her physician by repeating what the practitioner had told her: "I do hear that you are telling me not to examine my breasts and not to worry because I had a normal mammogram four months ago. I hear you don't feel any mass, and I really do respect your opinion."
• Then Jessica should have expressed her strong concern and asked for a test to reassure her: "I understand there is probably nothing abnormal, but I am still extremely worried, and if there is something abnormal, waiting six months could cost me my life. Would it be possible to order an ultrasound or a breast MRI to reassure me?"
• Had her physician said "no" and continued gaslighting her, she should have kindly thanked her physician and made an appointment with another practitioner for a second opinion.

We talked here about breast disease, but the same recommendations go for any medical problem.

Should Jessica have listened to her physician and stopped self-breast exams?

No, Jessica should have continued self-breast exams at least once a month (once a week if she felt something was growing) to make sure that what she felt was not getting bigger.

Most medical organizations and some physicians recommend against regular self-breast exams because they think people might panic too easily and request too many and too frequent unnecessary tests. But other physicians recommend self-breast exams once a month.

I highly recommend self-breast exams once a month: for example, the first day of each month for a woman who has already gone through menopause. For younger women, I recommend a self-breast exam every month on the seventh or eighth day after the first day of their periods. Men also get breast cancer, but it is much rarer (the CDC mentions that one out of 100 breast cancers diagnosed in the United States is in men).

Why do self-breast exams once a month?

According to the CDC, each year in the United States, about 264,000 women get diagnosed with breast cancer, and 42,000 women die from the disease.

Some physicians (me included) believe that doing regular self-breast exams in addition to regular mammograms can help detect early tumor growth. Some breast cancers will be slow-growing and will be detected by regular mammograms, but others could be fast-growing and very aggressive. In Jessica's case, her cancer probably started growing 2 or 3 months after her normal mammogram and grew very fast. Waiting another six months for a repeat mammogram was too long. Detecting and treating breast cancer early can make a difference as big as life or death.

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Mara Roth and colleagues published a study in the Journal of Women's Health showing that most women survivors of breast cancer detected their cancer themselves and concluded that self-detection remains a key method of breast cancer detection in U.S. women.

So, get used to the way your breasts usually feel: Some people have big, lumpy breasts, others have small, flat breasts. If your breasts feel like they always feel, there is usually no need to panic. If there is a change, make an appointment to see your doctor.

How to do self-breast exams:

Lie down on your back. To examine your left breast, put your left arm up above your head, take the three middle fingers of your right hand and gently press on each area of your left breast. To examine your right breast, put your right arm up above your head, do the same thing with the three middle fingers of your left hand. For both breasts, use light, medium, and then firm pressure. This exam can also be done standing in the shower. The technique is described well by the Mayo Clinic.

What not to do when performing self-breast exams:

Some people will be very anxious and do self-breast exams several times a day. This will not be helpful and could irritate the breasts. Don't examine your breasts more than once a week. And if doing a self-breast exam makes you too anxious, don't examine your breasts. Let your physician do the job.

Conclusion:

Physicians usually know best how to treat us, but sometimes we know our body better than our physicians do. So, get used to the way your body feels, and if you detect anything out of the ordinary, consult your physician.

If your physician gaslights you, answer by acknowledging you have heard, understood, and respected your physician's opinion, then voice your concern on the off chance you could be rightly worried, and ask for a radiological exam or blood test to reassure you. If your physician refuses, don't hesitate to get a second opinion from another practitioner. For that second opinion, choose a physician who is humble, who respects you and who takes the time to hear you, examine you, and address your concerns.

After all, nobody will ever know your body better than you because you live in it.

Copyright 2023 @Chris Gilbert, M.D., Ph.D.