An incendiary call to action

Now that “gaslighting” has been named “word of the year 2022”, everyone’s finding a use for it. Even “medical gaslighting” seems to be trending. But while “gaslighting” means treating someone in a way that makes them doubt themselves, their feelings, and their beliefs intentionally, I’d argue it’s very rare for a medical professional to do any of that on purpose.

Most doctors have been trained to wield their intelligence in ways that convey confidence and knowledge. Often, this gives us reassurance when we most need it. But we all know there’s a fine line between a voice that’s empathetic and one that’s patronizing, even silencing. This helps neither the sick nor those caring for them.?

Ask around. Nearly every one of us remembers a moment we felt unsure, unheard, embarrassed, or worse, while getting healthcare. To be fair, just as many people have amazing stories of heroic care givers. But it’s the former we need to do something about. Gaslighting cannot happen in healthcare. Not to the individual. Not to a family.? Not to a community.?

How to make sure we err, instead, on the side of listening and empathy? One big way is to prioritize another voice: the patient’s.?

Caregivers can help do this by actively working to understand a patient’s context and community, and treating them in a culturally concordant way. They can bring attention to the too-often unsaid in a patient’s life and history, creating a safe space no matter the patient. They can encourage self-advocacy. And they can listen, really listen.?

One stat that motivates me and the team at Included Health is that 40 percent of LGBTQ+ individuals report having been discriminated against in a healthcare setting, and that causes care postponement and avoidance. To help change this, we introduced our Communities LGBTQ+ offering, now with over 15,000 vetted providers focused on building trust with a community that faces barriers to great, personalized healthcare. As of January 1 next year, approx 2.5M people will have access to this offering. And approx 1M will have access to our Black Health offering. Two models for more programs to come.

Companies providing benefits to employees can help, too. They can renew their focus on behavioral health, as one powerful route to reach patients whose voices are unheard. Consider life beyond urban America, where 57M people in rural and tribal communities face increased mortality as a result of social inequalities, multiple chronic health conditions, high suicide rates, physician shortages, hospital closures. Behavioral health is one way to engage them, hear what they have to say, and get them what they need.

In partnership with our employer partners, we’ve seen a 25% increase in the number of members (patients covered by the employer’s benefit program) who have sought and found behavioral health treatment across the country. This number goes up to 35% for those in predominantly Black and Hispanic zip codes. And these members are also the ones we’re most successful engaging in other care, too.

People like you and me, and anyone else who becomes a patient can do our part as well. We can speak up even when medical settings make us nervous. A 2017 Mayo Clinic paper found that many patients, particularly those with a serious disease, behave “like hostages in the presence of physicians — unwilling to challenge authority, understating their concerns, requesting less than they desire.” This makes shared decision making “a pipe dream.” It shouldn’t be.

The more people speak up, and step up proactively to seek care (today, a quarter of Americans don’t have a primary care physician), the more their experience will improve. And that will have? ripple effects. People will get healthier. Our country will spend less on healthcare.

No, just because “gaslighting”? is a trending word doesn’t make it meaningful. Other words in Merriam-Webster’s top ten this year were “queen consort”, because of Camilla, and “loamy”, because of a Wordle in August. But hopefully, “gaslighting” can actually be incendiary. It should light a fire under all of us. To make sure the loudest voice in the room, from here on and always, is the patient’s.