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Duke Student Health: Gaslighting patients and exacerbating conditions

vital signs

The term “gaslighting”—the denial of someone’s reality in an attempt to invalidate or dismiss them—comes from the 1938 play and subsequent movie “Gaslight,” in which a husband manipulates his wife to the point that she questions her own sanity.

Sarah Ottey, founder of PCOS Challenge: The National Polycystic Ovary Syndrome Association, coined the term “healthcare gaslighting” to highlight the sexism and weight bias women often experience in navigating the healthcare system.

Duke students are also familiar with the phenomenon.

In my last column, I discussed sophomore Cate Schick’s encounter with Student Health—being told that she was “just stressed” when in fact, she was experiencing an allergic reaction, but that was only one of the many similar cases I heard.

Senior Kezia Matson has a blood regulation condition that, when left untreated, can cause chest pain, racing heart rate, fatigue and lightheadedness especially when standing up or walking—symptoms she had been experiencing for over a year. Last semester, she visited the ER three times due to extreme symptoms and accompanying fevers.

Matson tried to connect with a cardiologist in the Duke hospital, but she was told that as a Duke student, she needed a referral from Student Health.

At Student Health, a nurse practitioner saw in her records that she was previously diagnosed with anxiety, and decided that her symptoms were a manifestation of the mental illness.

Matson then explained that in the preceding summer, she tried to recover by stepping away from stress and working on a farm, and yet her symptoms continued to worsen. And that light physical activity exacerbates her symptoms, which would not be the case with anxiety. But the NP would not budge.

“She was very dismissive when I tried to give my thoughts,” Matson said. “It made her more defensive in the fact that she believed she was right, instead of taking in what I was saying.”

Matson read online that a tilt-table test—changing a patient’s position quickly and seeing how their heart rate and blood pressure respond—can be used to assess her symptoms, so she asked the NP to perform the test on her.

“She was very unhappy that I asked her to do it,” Matson recalled.

The test results indicated that her heart rate and blood pressure changing dramatically, but the NP insisted that the numbers didn’t show anything. Instead of referring Matson to a cardiologist as she requested, she referred her to a psychiatrist, which she already had.

Matson later learned that she should’ve been given a positive test result and further testing.

In the weeks following the appointment, she worked on mitigating her supposed anxiety.

“I really tried to tweak it from the standpoint of diet and wellness and when I didn't see results, it made me feel so guilty and frustrated,” Matson said. “I was being mad at myself for trying to control something that I can't control.”

Finally, she met with an off-campus general practitioner, who immediately referred her to a cardiologist.

Student Health’s misdiagnosis delayed Matson from receiving necessary treatment and medication, negatively impacting her academic, social and emotional well-being. The gaslighting, which led to her questioning and blaming herself for her physical suffering, may potentially have longer lasting effect.

A 2015 study interviewed women who had been hospitalized but avoided following up or obtaining routine care. Many cited anxiety about “being perceived as complaining about minor concerns” and “feeling rebuffed or treated with disrespect.”

Another senior—who asked that I only disclose his year—recognizes how damaging healthcare gaslighting can be, after he tumbled down the stairs and hit his head on the hand railing of a lecture hall.

He had had six concussions, so based on his experience, he was sure that this fall led to a seventh.

The doctor at Student Health, however, noted that he had a history of anxiety and was only “being anxious about having a concussion.”

He then asked the doctor to perform a concussion test, which he refused.

“This guy was so cocky about it,” he said. “He was like, you need to be knocked around to get a concussion. I’ve slipped in the shower and got a concussion.”

Without a concussion diagnosis, he continued to do activities that would worsen a brain injury—reading, looking at screens frequently and engaging in physical activity. As much as he pushed himself to work harder, his symptoms—memory loss, headache, fatigue, light sensitivity—caused him to frequently miss class and deadlines.

He recalled feeling conflicted between what the doctor said and how his body felt.

“I was like, I definitely have a concussion. I'm concussed. But then I was like, oh maybe I'm just anxious and they're right and I'm overthinking it,” he said. “I was alternating between ‘I feel horrible’ and blaming myself for feeling horrible.”

A week and a half later, his symptoms became so severe that he called his mom and asked her to take him to a neurologist, who quickly diagnosed him with a concussion.

The injury led him to STINF all of his midterms and miss another week and a half of school—almost three weeks of class missed in total.  

“I was struggling to catch up for the rest of the semester, and I don’t think it would’ve been that bad if I had been told right away that I was concussed,” he said.  

Student Health’s misdiagnosis and gaslighting not only impacted his academics and potentially caused permanent neurological damage, but also, ironically, caused him considerable anxiety.

The doctor’s words unleashed an odd mind game: He would think that he had a concussion, then become upset with himself for worsening his symptoms by doing what the doctor told him not to—“being anxious about having a concussion.”

Student Health’s deficiencies can have dangerous impact.

A psychological misdiagnosis can make a rare disease patient’s actual diagnostic delayed 2.5 to 14 times—0.5 to 12 times more than a non-psychological misdiagnosis—according to a survey of 12,000 European patients. That is time in which the disease can spread or further compromise the body.

A student’s record of mental illness does not provide an excuse to bypass one’s medical duties. Anxiety is not a Band-Aid that can be stuck onto any set of symptoms without further testing. By invalidating a patient’s suffering and undermining the voice in their own head, one is doing what Charles Boyer did to Ingrid Bergman—dimming and brightening the gaslights, but telling her she’s just imagining things. 

Rose Wong is a Trinity senior and a Local/National News Editor. 

Editor’s note: This column is part of a new recurring series on health at Duke called “vital signs.” If you have experienced a misdiagnosis at Student Health, contact Rose Wong at rosanna.wong@duke.edu.

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