As we continue our series on The Care Gap – Rethinking Women’s Health in Medicine, this fourth chapter examines a disturbing phenomenon known as medical gaslighting and how intersecting forms of discrimination (such as race, socioeconomic status, and other implicit biases), compound the challenges faced by women seeking medical care.

Medical Gaslighting

In 2023, the viral #MedicalGaslighting hashtag had over 250 million TikTok views, with women sharing stories of medical delays in treatment and of having their symptoms dismissed or attributed to stress, weight, or mental health. Many women have reported that it took years of persistence to obtain an accurate diagnosis for chronic conditions like endometriosis. This widespread phenomenon suggests a genuine crisis in women’s health that must be addressed. It is imperative that we work to eliminate implicit biases and change the way the medical community responds to women’s concerns.

In an interview with CNN, Maya Dusenbery, author of “Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick.”  summed up the experience of many women, “By and large, medicine has held onto the idea that any physical symptoms that cannot currently be explained physiologically can, by default, be attributed to the psyche. This idea is dangerous for all patients, and it continues to particularly harm women, who frequently encounter healthcare providers who say or imply that their symptoms are “all in their heads.””

This evidence isn’t just anecdotal – an increasing number of research studies and surveys corroborate these concerns [1]. In the UK’s “Women’s Health – Let’s Talk About It” survey 84% of respondents reported having experienced a medical professional being dismissive and not taking their health concerns seriously. A large-scale study on gender differences in the diagnosis of 112 diseases found that women consistently faced longer gaps than men between the onset of symptoms and a diagnosis, despite presenting with the same symptoms for a given condition [2]. Some researchers have suggested that it isn’t a lack of diagnostic testing that leaves patients feeling gaslit, but a lack of feeling heard and understood [3].

Women also encounter gender stereotypes that influence how their questions and requests for proper diagnosis and treatment are perceived. Assertive women are often unfairly labeled as “difficult patients,” which can lead to their concerns being dismissed and ultimately impair clinical outcomes.

Harvard Health has a great article on how to determine if you are experiencing medical gaslighting, with tips on how to document your symptoms to ensure your concerns are being taken seriously.  This is an area where continuing medical education (CME) can be enhanced to improve delivery of patient-centered care with training in areas such as patient-centered communication [4].

Intersectionality

The problem of health inequities becomes even more complicated when we include the interaction of other forms of discrimination. Black, Asian and Hispanic women, those from lower socioeconomic backgrounds, those with different sexual orientations, and those with higher body weights often face greater barriers to quality health care [5 -11].

This intersectional gap extends to our previous discussion on reference ranges, which were primarily derived from studies on males of European descent. A recent study on a healthy Ethiopian population found significant sex differences in median values for six blood markers, with reference range endpoints differing by over 10% between sexes for three markers. Additionally, 43% of participants, who were healthy adults, showed “abnormal” results by global clinical standards [12] .

In the US, non-hispanic black women are three to four times more likely to die from pregnancy-related causes than white women, and this disparity persists even when controlling for education and income levels [13].

Where ethnicity has been applied, it has historically been misused, including the assumption that black people feel less pain (and therefore do not need the same level of pain medication) [14], and incorrect assumptions resulting in misdiagnosis of kidney disease. In 2012, a large meta-analysis reported that patients with Hispanic/Latino backgrounds were 22% less likely than white patients to receive treatment with opioids for pain management, while black patients were 22% less likely to receive any prescription pain treatment, including analgesics [15]. Similarly, a more recent systematic review of post-operative pain treatment found that despite no real differences in reported pain, black, Hispanic and Asian women were less likely to receive adequate pain management[16].  Unfortunately, these forms of discrimination have led to disproportionate medical gaslighting when it comes to women of colour [16]. A massive study of 1.8 million medical notes from doctors and nurses at a US hospital revealed significant racial biases in pain management, patient perception, and time spent on diagnosis [6].

To address these systemic issues, we need to ensure anti-bias training is mandatory in both medical school and in CME. We need to transition from objective measures to biomarker-supported protocols, such as using functional MRI for chronic pain. Finally, we need to remove race from clinical decision tools and ensure physicians apply clinical guidelines and standardized checklists to reduce the bias that can come from individual discretion in medical decision-making.

In the next installment, we’ll shift our focus to health care challenges unique to women, such as endometriosis, PCOS, post-partum care, menopause and autoimmune disorders. Stay tuned as we discuss how care for these female-specific disorders is often inadequate or neglected due to systemic gaps in research, awareness, limited treatment options and medical training.

[1]        I. K. S. Ng, S. Z. L. Tham, G. D. Singh, C. Thong, and D. B. Teo, “Medical Gaslighting: A New Colloquialism,” Am. J. Med., vol. 137, no. 10, pp. 920–922, Oct. 2024, doi: 10.1016/j.amjmed.2024.06.022.

[2]        T. Y. Sun et al., “Large-scale characterization of gender differences in diagnosis prevalence and  time to diagnosis.,” medRxiv  Prepr. Serv. Heal. Sci., Oct. 2023, doi: 10.1101/2023.10.12.23296976.

[3]        S. Durbhakula and A. H. 6th Fortin, “Turning Down the Flame on Medical Gaslighting.,” Nov. 2023, United States. doi: 10.1007/s11606-023-08302-4.

[4]        J. E. Volkman, “Communication Rx: Transforming healthcare through relationship-centered communication,” Health Commun., vol. 35, no. 1, pp. 129–133, Jan. 2020, doi: 10.1080/10410236.2018.1536957.

[5]        P. N. Boakye et al., “Anti-Black Medical Gaslighting in Healthcare: Experiences of Black Women in  Canada.,” Can. J. Nurs. Res. = Rev. Can. Rech. en  Sci. Infirm., vol. 57, no. 1, pp. 59–68, Mar. 2025, doi: 10.1177/08445621241247865.

[6]        D. M. Markowitz, “Gender and ethnicity bias in medicine: a text analysis of 1.8 million critical  care records.,” PNAS nexus, vol. 1, no. 4, p. pgac157, Sep. 2022, doi: 10.1093/pnasnexus/pgac157.

[7]        S. Vohra-Gupta, L. Petruzzi, C. Jones, and C. Cubbin, “An Intersectional Approach to Understanding Barriers to Healthcare for Women.,” J. Community Health, vol. 48, no. 1, pp. 89–98, Feb. 2023, doi: 10.1007/s10900-022-01147-8.

[8]        S. Karanth et al., “Race, Socioeconomic Status, and Health-Care Access Disparities in Ovarian Cancer  Treatment and Mortality: Systematic Review and Meta-Analysis.,” JNCI cancer Spectr., vol. 3, no. 4, p. pkz084, Dec. 2019, doi: 10.1093/jncics/pkz084.

[9]        T. Akinade, A. Kheyfets, N. Piverger, T. M. Layne, E. A. Howell, and T. Janevic, “The influence of racial-ethnic discrimination on women’s health care outcomes: A mixed methods systematic review,” Soc. Sci. Med., vol. 316, p. 114983, 2023, doi: https://doi.org/10.1016/j.socscimed.2022.114983.

[10]     J. N. Fish, R. E. Turpin, N. D. Williams, and B. O. Boekeloo, “Sexual Identity Differences in Access to and Satisfaction With Health Care:  Findings From Nationally Representative Data.,” Am. J. Epidemiol., vol. 190, no. 7, pp. 1281–1293, Jul. 2021, doi: 10.1093/aje/kwab012.

[11]     A. S. Alberga, I. Y. Edache, M. Forhan, and S. Russell-Mayhew, “Weight bias and health care utilization: a scoping review.,” Prim. Health Care Res. Dev., vol. 20, p. e116, Jul. 2019, doi: 10.1017/S1463423619000227.

[12]     T. Fiseha, E. Alemayehu, O. Mohammed Adem, B. Eshetu, and A. Gebreweld, “Reference intervals for common clinical chemistry parameters in healthy adults of  Northeast Ethiopia.,” PLoS One, vol. 17, no. 11, p. e0276825, 2022, doi: 10.1371/journal.pone.0276825.

[13]     E. A. Howell, “Reducing Disparities in Severe Maternal Morbidity and Mortality.,” Clin. Obstet. Gynecol., vol. 61, no. 2, pp. 387–399, Jun. 2018, doi: 10.1097/GRF.0000000000000349.

[14]     K. M. Hoffman, S. Trawalter, J. R. Axt, and M. N. Oliver, “Racial bias in pain assessment and treatment recommendations, and false beliefs  about biological differences between blacks and whites.,” Proc. Natl. Acad. Sci. U. S. A., vol. 113, no. 16, pp. 4296–4301, Apr. 2016, doi: 10.1073/pnas.1516047113.

[15]     S. H. Meghani, E. Byun, and R. M. Gallagher, “Time to Take Stock: A Meta-Analysis and Systematic Review of Analgesic Treatment Disparities for Pain in the United States,” Pain Med., vol. 13, no. 2, pp. 150–174, Feb. 2012, doi: 10.1111/j.1526-4637.2011.01310.x.

[16]     K. L. Thurston, S. J. Zhang, B. A. Wilbanks, R. Billings, and E. N. Aroke, “A Systematic Review of Race, Sex, and Socioeconomic Status Differences in  Postoperative Pain and Pain Management.,” J. perianesthesia Nurs.  Off. J. Am. Soc.  PeriAnesthesia Nurses, vol. 38, no. 3, pp. 504–515, Jun. 2023, doi: 10.1016/j.jopan.2022.09.004.