Calling for Personal Stories of Gaslighting in a Medical Setting
Blog entry contributed by Tracey O’Connell, MD
Gaslighting is a form of psychological manipulation that involves abusers seeking control over other individuals by making them question their own judgment and intuition. Bullying is more overt — behavior or actions that people can see from the outside. Most people can witness bullying behavior and recognize that something isn’t right. Gaslighting is more subversive, but still a type of bullying. It dismisses a person’s reality, making them feel like they’re making things up, being “too sensitive,” or paranoid. It depends on having a gaslighter, who needs to be right, and a gaslightee, who needs thegaslighter’s approval at all costs.
Bullying & Gaslighting in Medicine
Medical culture is rife with bullying and gaslighting. It’s so ubiquitous, it’s like calling water wet. In the medical hierarchy, such behavior is used regularly as a way to maintain position in the ranks. Medical students may be afraid of residents and everyone above them. Residents may be afraid of fellows and attendings, and those people afraid of the chair, and the chair afraid of the administration. This vertical power structure limits an individual’s ability to speak out about what’s OK and what’s not OK.
It's so ironic that cruelty happens in medical culture because most people go into medicine for altruistic reasons, to help people, but then power erodes compassion, and all sorts of shit goes down.
The hierarchy in medicine is the perfect cover-up, allowing those with more power to minimize or make light of behaviors that wouldn’t be tolerated in other work settings.
Bullying behavior may involve abuse, humiliation, intimidation or insults. Gaslighting involves others telling others what to think, shaking their judgment, getting inside others’ heads and sabotaging their self-esteem. These tactics lead to great distress that may impact mental and physical health, superimposed upon the ordinary psychological stressors involved in the profession. Such unhealthy behaviors are more common in healthcare than in other industries and can prove detrimental to the delivery of quality patient care.
It may be surprising to hear that commonly, these damaging behaviors are done subconsciously as a response to feeling ‘not enough’ — not smart enough, not fast enough, not skilled enough. It’s a form of self-defense. Shame is often what causes bullying and gaslighting, and shame is also the result of such behaviors.
How Psychological Manipulation Manifests in Medical Culture
While bullying may be obvious to witnesses, gaslighting is more insidious as the dynamic occurs by shaking one’s perception of reality. It can manifest in the form of spreading rumors or planting seeds of doubt. Sometimes all it takes is someone commenting offhandedly to others, “I hope this person doesn’t come in late tonight, because they were late yesterday.” Then others may say, “Oh yeah, I noticed that, too. They are often late.” Little comments like this can put that person in the crosshairs. A similar result may happen if someone tells residents they aren’t going to pass boards.
There may be a denial of privileges, like the amount of time allocated to academic pursuits; being excluded from department emails, social events, or division meetings; undesirable shifts or duties given only to certain staff; denying or delaying promotions for an extended period without sufficient explanation or justification; repeatedly declining to put someone’s name forward for a leadership position or preventing some from sitting on or chairing committees; changing the “rules” without letting everyone know and then denying that anyone was left out.
Women, people of color, trainees, residents, and younger physicians tend to be the most frequent targets. Trainees need a degree to qualify as doctors, and residents need someone at a higher level to sign off on their certificate, for example. A person in a position of power can affect whether someone gets that degree or certificate. Younger physicians who aren’t familiar with a working group’s culture may have fewer support options or allies than more seasoned colleagues. They may have no one to champion for them.
How Leaders Can Create Psychological Safety in the Medical Workplace
When it comes to leadership’s role in preventing and eradicating bullying or gaslighting in the medical workplace, first and foremost they must have the desire to do so. If a leader doesn’t see an issue with the bad behavior, nothing will change. Those in positions of power need to set the tone for professionalism, inclusion, and flattening the hierarchy. Leaders should strive to create a welcoming and less formal environment. Assuming leadership is committed to reducing and eliminating toxic behavior, they need to be involved in the goings-on of their department. If they rely on intermediaries, they increase the likelihood of bias distorting the information they are given.It’s critical to know what’s going on with your people at the ground level in any organization. If folks don’t feel safe reporting a case of bullying or another form of harassment, they’re sacrificing their own well-being and potentially the safety of patients (1).
People find it difficult to talk about such behaviors.Understandably so. Many practices don’t even have a Human Resources department, but rather, establish internal “disciplinary action committees” that are often biased and untrustworthy. When there’s no safe place to share one’s own reality, experiences, feelings, or perceptions without judgment, criticism or blame, people shut down. They become dehumanized. Automatons. It’s easy to believe “this is just the way it is,” justifying staying in bad situations fora long time, until it becomes a choice between life and death. People can sacrifice their well-being for decades, until it becomes unsustainable.
That’s what happened to me. I left a private practice radiology job 6 years ago after working in a psychologically unsafe place for 16 years. A psychologically unsafe environment is a place where no one speaks up, offers support, or believes you. I realized I didn’t need to tolerate this— that I could go work somewhere else where I’m valued and can have relationships with colleagues based in mutual trust. I now do teleradiology and coach physicians who are being gaslighted and bullied.
Share Your Story
I am currently collecting stories of gaslighting in a medical setting (patients, trainees, nurses, physician assistants, technologists, physicians, etc.) to raise awareness and provide a safe outlet where people can share what’s happened to them (named or anonymously), and not only heal personally, but pave a new path forward professionally.
I’d love to start a #metoo movement around what’s true and what can no longer be tolerated. This story will culminate in an anthology of stories, a memoir, and an educational reference manual.
If you’ve read this far, I bet you have a story. Your story matters and is key to changing the current system.
You are not alone.
Please share your orthopaedic stories via this form and #speakuportho. For medical stories outside of the orthopaedic field please share with me tracey@traceyoconnellmd.com. If you would like to submit to both, please do.
Sources:
1. Content selected from Kelly, AM. Meltzer, CC. O'Connell, TH. Chonde, DB, Hudnall, CE. No bullying: Underreported bad behavior puts radiologists' well-being and performance at risk. ACRBulletin June 2023;78(6); 8-11.
