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Medscape
6 days ago
- Health
- Medscape
Am I Gaslighting My Patients?
Melissa Geraghty, PsyD, a clinical health psychologist at the US Department of Defense, developed unexplained episodes of lower body paralysis at the age of 34. 'I was told [by healthcare professionals] that it was 'just anxiety.' Throughout my life, I had been experiencing chronic pain and other odd symptoms but was told they were 'all in my head,'' she said in an interview with Medscape Medical News . Melissa Geraghty, PsyD Eventually, Geraghty was diagnosed with tethered cord syndrome, a rare neural tube defect requiring neurosurgery. Geraghty was a victim of medical gaslighting — the dismissal or minimization of a patient's symptoms. The term derives from a 1938 play (later adapted into a movie called Gaslight ), in which a husband intentionally manipulates his wife into questioning her perceptions of reality. The term 'gaslighting' became so popular that in 2022, it was identified by Merriam-Webster as its 'word of the year.' It has come to mean not only intentional manipulation of a person's perceptions but also dismissal of the person's legitimate concerns. In 2023, 'medical gaslighting' was trending on TikTok, garnering over 226 million views. A new review focuses on harm caused by medical gaslighting, which the authors refer to as 'symptom invalidation.' Researchers examined 151 qualitative studies, encompassing 11,307 individuals and 11 conditions, including long COVID, fibromyalgia, endometriosis, Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome, and systemic lupus erythematosus. The analysis identified broad classes of negative consequences: emotional states and beliefs (eg, self-doubt and shame), healthcare-specific responses (eg, loss of trust in clinicians), behavioral changes (eg, avoiding medical care), and diagnostic delays, leading to adverse outcomes. Allyson Bontempo, PhD 'Patients described questioning reality and asking themselves self-doubting questions such as, 'Am I making this up? Is it all in my head?' This can lead to long-term trauma and self-doubt and can adversely affect medical care going forward,' lead author Allyson Bontempo, PhD, a postdoctoral fellow at Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, told Medscape Medical News . Said Geraghty, 'This type of dismissal erodes trust and chips away at a person's sense of self.' It left Geraghty with 'medical trauma.' Respondents 'reported downplaying symptoms to their providers so as not to look overdramatic,' Bontempo recounted. 'Many such patients avoid healthcare providers, even for unrelated conditions, because they feel hopeless and think that nothing will come of their visit.' In these scenarios, diagnosis and treatment are delayed. Delays in diagnosis and treatment compromise the health of individual patients, and the negative sequelae of medical gaslighting go beyond its harmful psychological impact. It's a major public health issue, according to a report issued by the global healthcare safety nonprofit organization ECRI, topping the organization's 2025 list of the most significant threats to patient safety. Why Do Physicians Gaslight Patients? Devora Shapiro, PhD 'Physicians are under significant stress and strain, given continually increasing demands on their time and pressure from administrators to increase patient volume and decrease time spent in direct patient care,' Devora Shapiro, PhD, associate professor, Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, told Medscape Medical News . Physicians are also under tremendous pressure to justify their decisions (eg, ordering tests or performing treatments) to entities such as administrators and insurance companies. Alexandra Fuss, PhD, director of Behavioral Medicine in Inflammatory Bowel Disease at Massachusetts General Hospital, Boston, noted that 'with every medical decision, providers are authorizing the use of medical resources and must weigh the value of the service against the patients' needs, preferences, and circumstances.' Alexandra Fuss, PhD Physicians can find themselves needing to justify their medical decisions to patients 'who seem to think they know as much as their doctors or make specific requests for tests and treatments and have a customer-service mindset, where the provider is regarded as an employee who meets customer requests,' Fuss, an instructor at Harvard Medical School, Boston, told Medscape Medical News . Additionally, physicians are more vulnerable to engaging in dismissive behaviors when there are medically unexplained symptoms, maybe because complex stories or nonspecific symptoms 'don't fit neatly into the categories required by many health systems and insurance companies,' Bontempo explained. 'Lack of comprehensive objective testing or results that may not match expectations also contribute,' noted Anna Hayburn, PsyD, clinical health psychologist, Neuromuscular Center, and assistant professor of psychiatry, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland. 'Ambiguous symptoms are often attributed to psychiatric or psychosocial factors, even when those aren't the primary driver of the symptoms.' Anna Hayburn, PsyD Most of Hayburn's patients have complex neurologic conditions and 'have experienced some form of medical gaslighting and/or other forms of medical trauma throughout their healthcare journey. Providers often lack understanding of the symptoms or approach them with preconceived notions.' It can take years to receive a diagnosis and appropriate care. 'Patients are often burned out by the time that happens,' she told Medscape Medical News . The Role of Implicit Bias Fuss encourages medical providers to 'be mindful that we all have heuristics and biases that influence our behaviors and decision-making.' Zed Zha, MD, a family physician and dermatologist who practices at the Yakima Valley Farm Workers Clinic, Toppenish, Washington, told Medscape Medical News that her practice consists primarily of underserved populations — mostly immigrants. 'It's known that people of color, immigrants, members of the LGBTQ population, people with obesity or disabilities, and women more frequently have their symptoms dismissed, compared to White cisgender males, and I've seen this in my patients.' Zed Zha, MD For example, Zha treats patients with hidradenitis suppurativa (HS), a chronic inflammatory skin disorder characterized by painful lesions affecting intertriginous areas. HS disproportionately affects women and people of color and is typically associated with a 10-year delay between symptom onset and diagnosis. 'The diagnostic difficulty is compounded by the fact that this is a population more frequently dismissed and not taken seriously,' Zha said. Zha recalls a patient who had HS symptoms for more than 20 years without accurate diagnosis. 'The first thing she said was, 'I know I'm having these problems because I'm fat.' This is what she had been told by previous providers, and she accepted this flipped version of reality that was a totally untrue theory.' Another bias comes from the old adage, drummed into the heads of physicians from the first day of medical school: 'When you hear hoofbeats, think horses, not zebras.' This encourages physicians not to attribute a patient's symptoms to some rare disease but to look at more common conditions — an approach that can lead to dismissal or misattribution of symptoms in the quest to find a 'common' explanation, such as anxiety. 'A deeper question is what constitutes a 'rare' disease,' commented Zha . 'Are certain diseases actually rare, do they just more frequently affect women, people of color, transgender patients, or patients from other cultures?' Even common conditions are often missed in marginalized populations because of implicit bias. 'When we think about heart attack symptoms, we think about a hunched-over man with crushing chest pain, holding the left side of his chest or left arm. But that type of presentation isn't common in women. Women experience 'atypical' symptoms. By definition, if we're defining symptoms as 'atypical,' we're implying they're rare. But how can the presentation of a common medical emergency be defined as 'rare' if it affects women who comprise 50% of the population?' Misdiagnosis of myocardial infarction in women is more common than that in their male counterparts because 'atypical' symptoms are misattributed to anxiety and because of a stereotype that women are less affected by cardiovascular disease than men. Another myth is that Black people feel less pain, Zha noted. This misperception has contributed to undertreatment of pain in Black vs White patients. And women, more often seen as exaggerating pain, are less likely to receive pain medication than men presenting with the same complaints — a phenomenon Zha described as 'medical misogyny.' Zha asks herself throughout the day, 'How would I approach this patient's care if the patient were an able-bodied, thin-bodied cisgender straight White male without an accent?' She acknowledged that this self-investigation requires 'courage,' adding, 'every day, I'm still working on it.' Tips for Physicians The experts offered tips to help physicians avoid medical gaslighting. Don't be afraid to admit you don't know the answer. 'Most patients aren't expecting perfection,' Geraghty said. 'They're looking for someone to walk alongside them. Saying, 'I may not know yet, but I'm committed to figuring it out with you' is far more supportive than minimizing symptoms or blaming the patient.' You don't have to do everything the patient wants. Patients, often armed with articles from the internet, may ask for a medication, procedure, or test that's not warranted for their condition or symptoms. If this happens, 'take a moment to explain why that's the case, which can reduce the patient's feeling of being dismissed,' Hayburn advised. Some patients have developed their own hypotheses about what's causing their symptoms, which may not be 'based in empirical evidence,' Fuss added. 'The willingness to listen to their perspective regarding causation is important for establishing trust.' But this doesn't mean physicians are 'required to defer to patients' perceptions about the etiology of their symptoms.' Be careful about 'diagnostic overshadowing.' 'Be mindful not to over-engage in diagnostic overshadowing,' Fuss warned — a process by which healthcare professionals wrongly attribute a person's physical symptoms to other causes, such as disability or mental illness. She encouraged physicians to engage in 'thoughtful communication' when discussing potential psychological interventions. For example, patients with irritable bowel syndrome 'often describe unhelpful messages they've heard in the past, such as 'it's all in your head' or 'it's just stress.' So it's important to communicate the role of the gut-brain axis and discuss how psychological support is a valid treatment option recommended as part of comprehensive healthcare, as psychological factors can influence physical symptoms. Providers should emphasize that they'll continue to work on addressing [physical] symptoms as well.' Empathetic demeanor and validation build trust. Demeanor is an important component of helping people feel valued and taken seriously. Fuss advises clinicians to build trust by 'bolstering perceptions of competence and warmth.' Competence includes intelligence, skill, and assertiveness, while warmth includes qualities such as empathy, kindness, and honesty. Demonstrating both qualities also builds trust. An empathetic demeanor also includes validating the patient's statements, which 'doesn't take a lot of time but just takes intention,' according to Geraghty, whose private practice includes a specialty in medical gaslighting. 'You can say something like, 'I believe you' or 'that sounds really difficult,' which only takes a few seconds. That kind of acknowledgment can completely change the tone of the appointment.' Allow patients to ask questions. 'Asking if the patient has any questions means patients are more likely to feel heard and listened to,' said Fuss. Despite the compressed nature of medical appointments, time can be reserved for questions at the end of the visit. If patients require additional time for the discussion, a follow-up appointment can be scheduled. Validation isn't the same as reassurance. Bontempo recommends that physicians 'do not reassure patients that their symptoms are 'normal,' especially if they've been living with them for a long time and have distress about them. Patients know when something is wrong with them, especially the longer they live with their symptoms.' Research suggests that reassurance isn't helpful to patients with high distress about their symptoms and may be perceived as dismissive. So instead of reassurance, Bontempo recommends validation. 'Many patients who struggle to receive a diagnosis actually have reported wanting to have their symptoms validated independent of whether a diagnosis can be identified. At the very least, this validation reassures patients that they are not crazy and offsets the self-doubt that ensues from being undiagnosed, which is only exacerbated when physicians normalize their symptoms.' A Call for Action Although the term 'medical gaslighting' has 'exploded,' it has garnered relatively little formal research, Zha pointed out. Furthermore, 'some are even arguing that we need to abandon the term because it's cynical and not good for our business.' But that itself is a form of gaslighting — acting as though a real problem doesn't exist. 'The popularity of the term is a message to us. Rather than putting our energies into eliminating this term, let's put our energies into providing patient care that is affirming and takes symptoms seriously.' Geraghty emphasized that her statements reflect her own views and not those of the US Department of Defense, and Zha emphasized that her statements reflect her own views and not those of the Yakima Valley Farm Workers Clinic. Hayburn, Fuss, Geraghty, Zha, and Shapiro reported having no relevant financial relationships.
Time Business News
10-07-2025
- Health
- Time Business News
Everything You Need to Know Before Opening a Mental Health Clinic
Before any formal steps, define what kind of mental health clinic you want to open. Will you focus on individual therapy, group counseling, psychiatric medication management, or trauma recovery? Decide whether your clinic will specialize in children, adolescents, adults, or underserved populations. Establish your treatment philosophy—whether rooted in evidence-based practices, holistic care, or culturally responsive models. A strong, purpose-driven vision ensures that every business, clinical, and marketing decision aligns with your long-term goals and community impact. Starting a mission-driven service in the mental health space requires more than just clinical passion—it demands strategic planning, legal understanding, and a strong operational foundation. From identifying your niche to understanding licensing and compliance, every detail matters. Understanding how do I start a mental health business involves researching your target population, establishing a business entity, securing funding, and hiring qualified professionals. Equally important is creating a strong referral network and marketing plan to build trust and reach clients. With clarity of purpose and a commitment to ethical care, your mental health venture can create lasting community impact. Select a legal entity that offers liability protection and tax advantages—typically an LLC or professional corporation for mental health businesses. Register the business with your state's corporate division and obtain an Employer Identification Number (EIN) from the IRS. Choose a name that reflects professionalism, trust, and your clinical approach. It should resonate with your audience and comply with state naming laws. Securing a business structure early paves the way for bank accounts, insurance contracts, leases, and payroll systems. Your clinic must meet state-specific licensing requirements for outpatient mental health services. These may involve facility safety, staffing ratios, clinical protocols, and policy documentation. Individual clinicians also need to be licensed (e.g., LCSW, LMFT, LPC, PsyD, MD) based on their discipline. Start insurance credentialing as early as possible—becoming an in-network provider with Medicaid, Medicare, and commercial insurers can take several months. Implement HIPAA-compliant systems for storing medical records, protecting client information, and handling telehealth. Compliance is not just regulatory—it's a critical foundation for operational integrity and trust. Find a location that's accessible, comfortable, and designed for confidentiality. Ideal clinics include private therapy rooms, a client-friendly reception area, staff offices, and space for groups if needed. Ensure ADA accessibility, soundproofing for privacy, and zoning approval for healthcare use. Choose calming colors, natural lighting, and subtle decor to foster a safe, welcoming atmosphere. Whether leasing or owning, the facility should enhance the therapeutic experience and reflect your clinic's quality of care. Hiring the right people is central to clinical success. Depending on your services, recruit licensed therapists, psychologists, psychiatrists, case managers, and administrative staff. Look for professionals trained in trauma-informed care, evidence-based treatment, and cultural competence. Build a positive team culture rooted in ethics, transparency, and shared purpose. Offer regular supervision and support continuing education. A well-supported, mission-aligned team improves client outcomes, reduces turnover, and builds your clinic's reputation from the inside out. Establish a structured process for client intake, assessment, treatment planning, documentation, and discharge. Use an Electronic Health Record (EHR) system built for behavioral health to streamline charting, scheduling, and billing. Develop written policies for crisis intervention, client complaints, documentation standards, and safety protocols. These systems ensure quality control and prepare your clinic for audits, payer reviews, and future accreditation. Efficiency and consistency in clinical operations lead to better care and a more sustainable business. Budget for every element of startup and early operations—rent, payroll, furniture, technology, marketing, licensing fees, insurance, and legal support. Estimate your operating costs for at least six months, factoring in delays in insurance reimbursements. Set fees for cash-pay clients and estimate reimbursement rates from various insurers. Choose a billing system or professional to handle claims, coding, and collections. A strong financial plan helps you stay afloat, expand services, and reinvest in your clinic's future without compromising care. To attract clients and referral partners, develop a professional website that highlights your services, staff credentials, treatment philosophy, accepted insurances, and contact details. Optimize for local search so nearby clients can find you easily. Network with primary care providers, school counselors, hospital discharge planners, and social services. Consider offering workshops or blog posts to position your clinic as a mental health resource in the community. Focus on transparency, education, and authenticity—ethical marketing builds long-term trust and credibility. Start small and scale thoughtfully. Launch with core services and a manageable caseload to ensure operational systems and staff are functioning smoothly. Collect client feedback, monitor documentation and billing workflows, and address any gaps. Track key metrics like client retention, satisfaction, staff utilization, revenue cycle performance, and clinical outcomes. Use this data to improve service delivery, make staffing decisions, and demonstrate value to insurers and community partners. A successful launch depends not just on readiness but on a commitment to continuous improvement. Achieving excellence in behavioral health services requires more than clinical expertise—it demands adherence to nationally recognized quality benchmarks. Organizations striving for higher standards often pursue certifications that demonstrate their commitment to safety, care, and accountability. JCAHO Accreditation for behavioral health is a key milestone that signals an organization's compliance with rigorous performance and quality standards. This accreditation not only enhances credibility with patients and payers but also improves internal operations through structured evaluation and continuous improvement. By meeting these standards, facilities position themselves for long-term success while fostering trust within the communities they serve. Opening a mental health clinic is a major undertaking—both a clinical mission and a business venture. With thoughtful planning, regulatory compliance, ethical leadership, and financial strategy, you can create a space where healing happens consistently and professionally. Your clinic can become a pillar of support in your community, a source of hope for individuals in need, and a business that sustains itself through integrity and care. When you build with intention, success is not just possible—it's inevitable. TIME BUSINESS NEWS
Daily Maverick
25-06-2025
- Health
- Daily Maverick
Looking for mental health or wellness advice in a book? Check the author's credentials first
The effectiveness of a self-help book depends largely on the quality of its content and how it is used by readers. Self-help books are a mainstay of the non-fiction market. According to a 2022 study by BookNet Canada, self-help titles account for 17 per cent of non-fiction book sales. Some of these books can go on to sell millions of copies, but popularity doesn't always equal credibility. Achieving bestseller status can reflect effective marketing campaigns, a large social media following or the appeal of personal storytelling rather than academic or clinical credentials. To better understand the current self-help landscape, my graduate student and I are reviewing New York Times bestsellers under the 'Advice, How-To & Miscellaneous' category, which includes self-help books. Our preliminary analysis for April 2025 identified 22 relevant books, with only three written by authors with advanced training in psychology or medicine: Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents by Lindsay C. Gibson, PsyD The Ageless Brain: How to Sharpen and Protect Your Mind for a Lifetime by Dale E. Bredesen, MD The New Menopause by Mary Claire Haver, MD This isn't a new issue. A 2008 study examining 50 top-selling books directed at anxiety, depression and trauma found that more than half contained strategies that were not supported by evidence. Can self-help books help? It depends The effectiveness of a self-help book depends largely on the quality of its content and how it is used by readers. Books that draw on peer-reviewed research are more likely to offer reliable, evidence-based strategies for improving well-being. Peer review is a process in academic publishing where experts in a given field vet a research study's quality before it's published. This process helps ensure the research is of high quality and adheres to the standards of the discipline. Evidence-based books are ones that rely on peer-reviewed research to support their claims and suggestions for improved well-being. Having psychological science make its way to the general public via self-help books can provide a useful resource to support well-being and self-improvement. In contrast, books that are based on someone's opinion or their lived experiences have not had their ideas tested or verified. Although these books can contain useful information that were helpful to the author, they can also be problematic, as the ideas have not been empirically examined. Risks of non-evidence-based self-help books Relying on untested self-help strategies can delay people from seeking appropriate support for the challenges they face. When they turn to self-help books instead of seeking professional care, it can lead to worsening symptoms and missed opportunities for effective treatment. This can have serious consequences, particularly for those dealing with complex mental health challenges like anxiety, depression or trauma. In addition, exposure to misinformation or disinformation can make matters worse. When such content circulates widely, like through best-selling books, it can reinforce harmful stereotypes or downplay the seriousness of psychological distress. This can perpetuate stigma and make people feel ashamed or reluctant to seek therapy, medical treatment or other professional help. At the same time, the booming global wellness industry has created new risks for consumers. In 2023, the wellness industry was valued at an estimated US$6.3 trillion. The size and growth of the industry has created fertile ground for wellness grifters to financially exploit people's desire for better health and happiness. Community for science-based self-help readers If you're interested in more evidence-based books for well-being and self-improvement, consider joining my Reading for Well-Being Community Book Club. Each month, members receive a newsletter announcing 'Professor Pozzulo's Pick' — an evidence-based book chosen by me that is focused on some dimension of well-being or self-improvement. The newsletter also provides access to a digital platform where my review will be posted, along with a discussion board where club members can share their thoughts about the book. Membership is free and sign-up is located here. You can also hear directly from the authors of the selected books through the Reading for Well-Being Podcast, which provides deeper insight into the evidence and ideas behind each book. Summer reading recommendations For readers seeking self-help books supported by research, here are four accessible and evidence-based suggestions: The Positive Shift: Mastering Mindset to Improve Happiness, Health, and Longevity by Psychologist Catherine A. Sanderson (2019, Published by BenBella Books). Sanderson explains that our level of happiness, physical health and even our longevity is connected to how 'we think about ourselves and our world around us.' In other words, our mindset. By making small changes, Sanderson shows how we can improve our happiness and physical and mental health. The book is full of straightforward, science-backed strategies to 'shift your mindset.' One study Sanderson highlights found that people who read for more than 3.5 hours per week tended to live longer. Chatter: The Voice in our Head, Why it Matters, and How to Harness It by Ethan Kross (2021, Published by Crown Publishing Group). Anyone who has found themselves lying awake in the middle of the night with endless thoughts of potential doom can likely relate to this book. In Chatter, psychologist Ethan Kross examines this inner voice. According to Kross, by changing the dialogue we have with ourselves, we can potentially change our lives and ultimately improve our health and well-being. The last section of the book, titled 'The Tools,' includes several evidence-based strategies to reduce the negative loops that can run in our minds. Happier Hour: How to Beat Distraction, Expand Your Time, and Focus on What Matters Most by Cassie Holmes (2022, published by Gallery Books). Do you ever feel like you never have the time for the things you want or need to do? Management professor Cassie Holmes writes that people who are 'time poor' can 'feel less happy and less satisfied with life.' Several studies have found that when people make time to do the things they want, they feel they have more time to do the things they need. Holmes encourages readers to reflect on how they spend their time. Although we can't change the amount of time we have, we can re-prioritise how we spend it, and by doing so, improve our sense of well-being and life satisfaction. How to Change: The Science of Getting from Where You Are to Where You Want to Be by Katy Milkman (2021, published by Portfolio). If you feel like you need a change or find it hard to make a change last, you might be using an ineffective strategy or approach. Economist Katy Milkman reviews the science of how to make behaviour change last with several evidence-based strategies to help you reach your goals. Each chapter examines an internal obstacle that stands between people and their goals. By the end of the book, you'll learn how to recognise these obstacles and what you can do to overcome them. DM This story first appeared in The Conversation. Joanna Pozzulo is a Chancellor's Professor of Psychology at Carleton University.
Bloomberg
08-04-2025
- Entertainment
- Bloomberg
Chappell Roan Made Discomfort in Motherhood Seem Like a Bad Thing
The pop star's comments comparing parenthood to 'hell' garnered both support and criticism, but both sides appeared to be operating under a flawed assumption. By Sarah Gundle, PsyD is a psychologist in private practice and an assistant clinical professor at the Icahn School of Medicine, Mount Sinai Medical Center. Save 'All of my friends who have kids are in hell.' When Chappell Roan said these words on a recent episode of the Call Her Daddy podcast, she probably didn't foresee the online firestorm they would create. The 27-year-old pop star went on to say that she doesn't know anyone her age with children who is 'happy, well-rested, or has light in their eyes.' Before it's here, it's on the Bloomberg Terminal
