Gaslighting Kills

The term gaslighting has become popular today after a relatively quiet existence since the 1944 movie with Ingrid Bergman and Joseph Cotton titled “Gaslight.”  In this movie, Joseph Cotton, Ingrid’s husband, tried to make Ingrid Bergman think she was going crazy so he could put her away and take over her wealth.

     I’ve always thought that a healthcare provider was supposed to be nonjudgmental. Whether nurses, nurse practitioners, PAs, lab techs, PTs or MDs, we get to leave our personal opinions, fights with spouses, political persuasions, and sometimes even our own personal illnesses at the door when we enter the clinic or hospital. We don’t get to judge people. And we really don’t get to treat people with less than our best care just because we might not approve of their lifestyle choices. Most of all, we don’t get to blame people for their illnesses. For example, “You smoked cigarettes. Now you have lung cancer and you brought this on yourself.”

     When we decide to treat some patients differently because of our negative judgments, we are first and foremost violating our Hippocratic Oath. This is nowhere truer than with patients who have the dual diagnoses of opioid dependency and any other condition. It is common to blame them because we don’t have any sympathy for opioid addiction, something we consider a lifestyle choice. We may consider them to be morally or socioeconomically inferior and hence deserve to have their illnesses, whatever they may be.

     Although there are caretakers who think they have the right to blame patients for their illnesses, they certainly do not have a right to act upon that belief. Gaslighting cost the life of a 32-year-old patient of mine who came under another physician’s care. Some of the caretakers even blamed her after she was dead, denigrating her for her life choices. Basing patient treatment on this kind of behavior is unethical and should have no part in patient care.

     What exactly was this patient’s crime, the one deserving death? She had a lung abscess with pneumococcal pneumonia. She also had opioid dependency. This made treating her difficult. Not that there was anything so intrinsically difficult to treat with that dual diagnosis. The problem was that there were several providers who disapproved of her lifestyle choices and took out their personal feelings on her. This made treating her very difficult.

     There are many providers who think they must immediately begin treating the opioid use issue, especially withdrawing the opioid, that makes treating the primary health problem, the reason the patient is in the hospital, very difficult to handle. The lung abscess became complicated to treat because so much conflict had been generated over the patient’s opioid use. For the patient, then, withdrawal becomes the primary issue. The simplest and most straightforward care plan was to keep the opioid dose constant, as it was at home, so that opioid dosing did not become the focus of the care, and treat the lung abscess the way it would be treated in any other patient.

     If we let our personal gaslighting interfere with the opioid care, it follows that the care of the lung abscess will also be negatively impacted. The skirmishes between the providers and the patient became the main focus of care, subtracting from what should have been our main focus, the treatment of the lung abscess. Because I could not stop the skirmishes, the patient discharged herself prematurely.

     Unfortunately, the provider who took over this patient’s care after I retired could not get past the opioid judgment and forgot about the lung abscess. My former patient was seen in the clinic four days before she bled to death at home from disseminated intravascular coagulation (DIC) due to sepsis from the ruptured pneumococcal pneumonia lung abscess. There are still some who think she deserved to die because of her lifestyle choices. This is a tragedy, not only for the patient’s  family, but also for the disintegration of medical care with the gaslighting of patients. In my experience, gaslighting has become increasingly common in our profession. Both of this patient’s conditions were treatable. Nobody should pay with their lives because of medical gaslighting.