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Gaslighting in medical systems refers to the mistreatment patients experience when their concerns are minimized, doubted, questioned, second-guessed, or outright denied by clinicians (Agarwal, 2023). A common example is when clinicians dismiss a patient's symptoms by attributing them solely to stress, poor nutrition, mental health, obesity, or lack of exercise. Such patients may feel that their health concerns have been unjustifiably dismissed and that the clinician, appearing unable to hear their claims, denies them the status of a patient, categorizing them as "just plain crazy" (Sebring, 2021).Despite frequent references to gaslighting of patients in the media, there are few scholarly articles on this topic in academic journals (Caron, 2022;Rubin, 2020). | GASLIGHTING IN MEDICAL SYSTEMSDiseases in which gaslighting has been described include inflammatory bowel disease (Actis et al., 2019), endometriosis (Hudson, 2022), peptic ulcers (Radomski et al., 2021), long COVID (Au et al., 2022, chronic liver disease, and Lyme disease (Baarsma et al., 2022;Dumes, 2020). Refusal to order imaging or lab work, or dismissing the results of blood tests, may contribute to the gaslighting of patients (Durbhakula & Fortin, 2023;Fagen et al., 2023).Being forced to doubt things over which one ought to have firstperson authority can disempower the patient and give rise to selfdoubt and self-distrust (Barnes, 2023;Sweet, 2019). Epistemic gaslighting, as opposed to manipulative gaslighting, can occur when the gaslit are weaker than the perpetrator, causing them to doubt their own epistemic capacity in a way that belittles and degrades them (Sweet, 2019). Importantly, gaslighting of patients by clinicians may occur without intentionality from the clinicians, if the patient is driven to doubt their interpretive abilities in a way that is causally related to systematic epistemic injustice, a process that increases vulnerability to such doubts (Sebring, 2021). | WHAT ARE THE RAMIFICATIONS OF GASLIGHTING OF PATIENTS?Long-term effects of gaslighting include anxiety, depression, PTSD symptoms, and trauma (Merone et al., 2022). This creates a vicious cycle as psychological symptoms can exacerbate physical symptoms.Clinicians who suggest, either directly or indirectly, that patients' physical pain is attributable to psychological issues (e.g., somatic symptom disorder or anxiety) may cause or exacerbate those very issues. In addition to diagnostic difficulties and feelings of being dismissed, gaslighting causes patients to feel stigma, prejudice, shame, and blame, and to develop a fear of seeking clinical help due to concerns about reactions to their past and present medical issues (Merone et al., 2022). Gaslighting occurs following communication in dyadic interactions connecting ethical, psychological, and sociological perspectives. | THE STATE OF THE ARTResearch on gaslighting in medical systems has primarily adopted psychological and sociological perspectives. Approximately 15 academic articles have examined gaslighting in the context o...
Gaslighting in medical systems refers to the mistreatment patients experience when their concerns are minimized, doubted, questioned, second-guessed, or outright denied by clinicians (Agarwal, 2023). A common example is when clinicians dismiss a patient's symptoms by attributing them solely to stress, poor nutrition, mental health, obesity, or lack of exercise. Such patients may feel that their health concerns have been unjustifiably dismissed and that the clinician, appearing unable to hear their claims, denies them the status of a patient, categorizing them as "just plain crazy" (Sebring, 2021).Despite frequent references to gaslighting of patients in the media, there are few scholarly articles on this topic in academic journals (Caron, 2022;Rubin, 2020). | GASLIGHTING IN MEDICAL SYSTEMSDiseases in which gaslighting has been described include inflammatory bowel disease (Actis et al., 2019), endometriosis (Hudson, 2022), peptic ulcers (Radomski et al., 2021), long COVID (Au et al., 2022, chronic liver disease, and Lyme disease (Baarsma et al., 2022;Dumes, 2020). Refusal to order imaging or lab work, or dismissing the results of blood tests, may contribute to the gaslighting of patients (Durbhakula & Fortin, 2023;Fagen et al., 2023).Being forced to doubt things over which one ought to have firstperson authority can disempower the patient and give rise to selfdoubt and self-distrust (Barnes, 2023;Sweet, 2019). Epistemic gaslighting, as opposed to manipulative gaslighting, can occur when the gaslit are weaker than the perpetrator, causing them to doubt their own epistemic capacity in a way that belittles and degrades them (Sweet, 2019). Importantly, gaslighting of patients by clinicians may occur without intentionality from the clinicians, if the patient is driven to doubt their interpretive abilities in a way that is causally related to systematic epistemic injustice, a process that increases vulnerability to such doubts (Sebring, 2021). | WHAT ARE THE RAMIFICATIONS OF GASLIGHTING OF PATIENTS?Long-term effects of gaslighting include anxiety, depression, PTSD symptoms, and trauma (Merone et al., 2022). This creates a vicious cycle as psychological symptoms can exacerbate physical symptoms.Clinicians who suggest, either directly or indirectly, that patients' physical pain is attributable to psychological issues (e.g., somatic symptom disorder or anxiety) may cause or exacerbate those very issues. In addition to diagnostic difficulties and feelings of being dismissed, gaslighting causes patients to feel stigma, prejudice, shame, and blame, and to develop a fear of seeking clinical help due to concerns about reactions to their past and present medical issues (Merone et al., 2022). Gaslighting occurs following communication in dyadic interactions connecting ethical, psychological, and sociological perspectives. | THE STATE OF THE ARTResearch on gaslighting in medical systems has primarily adopted psychological and sociological perspectives. Approximately 15 academic articles have examined gaslighting in the context o...
Background During the most critical phases of COVID-19 pandemic, dramatic situations were experienced in hospitals and care centers that nurses could hardly verbalize. Especially relevant were deep challenges related to terminal illness, situations of extreme sacrifice, as well as reflections on protective measures mixed with beliefs. We intend to analyze which problems had the greatest impact on professionals. Aim The aim is to explore the ultimate basis for action when making decisions and the orientation of their behavior in the face of moral conflicts. Method The methodological strategy is an interpretive synthesis. Narrative review of academic articles that analyzed ethical dilemmas during the pandemic was carried out by searching five databases (Pubmed, Scopus, Psycinfo, CINHAL, and WOS) between January 2020 and December 2022. Finally, 43 articles were selected. Ethical Considerations Ethical requirements were respected in all study phases. Results The reading and review of the 43 articles initiated the first phase of inductive coding which resulted in 14 initial sub-themes. Based on this structure, a second phase of coding was carried out, giving rise to six categories or emerging themes. To facilitate the process of identifying the central category, the authors agreed to carry out a phase of synthesis, grouping the six themes into three meta-themes: the identification and acceptance of human vulnerability; the discovery of positive paradigms in traumatic situations in society; the prevalence of the common good over the particular interest, as the core structure of any society. Conclusion The study has shown the need to consider healthcare benevolence as a new dimension of health care upon global vulnerability. Responsibility is required to ensure the well-being of a global society, prioritizing the common good over particular interests and building solutions on solid moral structures. A new ethical landscape is essential, starting with a humanistic curricular training of all healthcare professionals.
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