Transcription of Podcast

Julie Soukup  0:00  
All right. Hi, my name is Julie Yorumez. And I am very excited to have my guest today her name is Amber belt, she works with sage Sharona, and she's a I actually found her on Instagram when I was looking at different ways that doctors are are addressing communication challenges patient communication challenges. And, and she brought up a topic that I thought was incredibly interesting, which was talking about medical gaslighting. And this was something I had never I've heard of gas lighting before, but I had never really heard about it in a medical space. And so instantly, I said, Hey, can you on my podcast, and not only just educate me about what this means and what this means for patients, and what doctors can kind of do to make sure they're, they're not being perceived as gas lighters, and just kind of explain a little bit more about it. So with that, let me let actually you or Dr. Bell, introduce yourself a little bit more of your experience. And let's kind of start diving right into to what is medical gaslighting? Sure.

Amber Belt  1:07  
So I'm, I'm a naturopathic physician. And so what that means, if you're not familiar with what a naturopathic physician is, is we attend a four year medical school, the first two years are pretty similar to what you'd get in a conventional medical school with anatomy and physiology and biochemistry and, and that type of thing with those basic sciences. When we start to kind of delve into how to treat patients, that's kind of where we, we have a new philosophical and treatment difference from conventional medicine. You know, we work more with nutrition, herbal medicine, homeopathics, you know, those kinds of things, as treatment plans, and I certainly can prescribe drugs, and do minor surgery, but those types of treatments are more second line for me rather than first one. Sure, sure. So,

Julie Soukup 2:03  
so what what definitely, and that's kind of also becoming something more common recently, too, or something that even I'm understanding more, maybe it's more of a personal thing, my dad's had spine surgery has a ton of pain. And he's now really leaning into more of the natural aspects that he can do to also help remedy these things. And even in addition to what he's already doing, just to kind of get a little more like physiological, like support there. And so So yeah, I can I mean, definitely, it's a it's something that we're learning about, you know, all the time and then especially more in the space. So what is it even with that psychological difference there? Kind of what then explain a little bit more about what medical gaslighting is and, and why that difference in perception is, is kind of important and addresses that.

Unknown Speaker  2:52  
Yeah. So, um, medical gaslighting happens when a patient's symptoms or blown off or dismissed or denied by their practitioner. And so that that interaction there where their symptoms are invalidated, or where they are blown off, it really invalidates the patient with their experiences. So the practitioner might be telling the patient that their symptoms aren't that bad, or that their symptoms couldn't possibly be due to their condition, or they couldn't possibly have this many symptoms happening at the same time. And what happens in this case is a lot of times medical gaslighting will stop the process of the patient getting proper workup to get them diagnosed and treated correctly. Which, you know, that's good to have your patient not getting treatment or getting a big delay in treatment. Right, right. invalidation. Yeah, and I think the way that it kind of the two paths, you know, the two different paths between, you know, my practice and positional practice. With naturopathic medicine, we really try to see the whole person and I think a lot of times in conventional medicine, just due to the nature of the way it's set up, it's more compartmentalized. So yeah, this patient with this huge collection of symptoms that don't fit sort of into that specialty. Yeah, a lot of times medical gaslighting can occur. Sure.

Soukup  4:35  
And then also is maybe they have a couple things wrong and it's not just one solution might be five solutions. You know, when when those type of things are happening where a patient is not feeling kind of heard or validated, and especially like their pain, or their pain places aren't making as much logic or even in like some of the chronic illnesses that patients have i What is the impact that that has on a patient and their kind of, you know, desire to seek care, I guess. Yeah.

Unknown Speaker  5:05  
Yeah, I think a lot of times, you know, when patients report to me that these experiences are happening to them, you know, they get really confused, and they get scared. They get, and then they get anxious about seeing that practitioner. And so maybe they won't, they won't go to their scheduled follow up as they're supposed to, or they won't get their labs done, because they're just trying to avoid that negative interaction that they've had with a practitioner. Yeah. So I think what happens is they delay care, or they can even stop care. Yeah. Not feeling heard? Well, I'm one and

Julie Soukup  5:43  
that makes me the one thing I also think even with that, that you said, in our previous conversation that was really interesting is when you're talking about, well, some of the restrictions and some of these providers have in there. And that's where it can kind of seem like a minor might be medical gaslighting, because they're not, you know, recommending certain, like labs or certain scans or anything along those lines. But the reality is, is that there's, there's kind of like an operational barrier with with these things, too, as far as like that they can't get some of these, you know, things completed.

Unknown Speaker  6:18  
Yeah, yeah. And I have to call myself out a little bit, because I have a cash practice. So I don't deal with that. Especially when you're talking about insurance coverage. I don't have to deal with that as much as a conventional practitioner. But I think I get enough of a taste of it, to understand to some degree like, you know, yeah, so you know, it's quite understanding that the way the system works, yeah, if your patient doesn't fit the box of condition, a, you're not going to be able to get, you know, the labs, or the treatment, or the imaging or whatever you want off the patient. And I think that can really, it frustrates me and I don't have to deal with it all day, every day. Yeah. So I think that can spill over to the patient. And you can't get the labs you want for them to see, to dial their audition. So you can see it correctly. So then maybe you get frustrated with the patient, and their numerous complaints, and then you sort of inadvertently get

Julie Soukup 7:23  
by Yeah, no, absolutely. And I think that's, I mean, so that's kind of an interesting question, as I didn't really understand that, that it can be the case, in some of these places. And I would assume, and I feel like I kind of understand medicine, just because of my experience. But I would assume that maybe a lot of patients may not understand kind of the complexities of some of the reasons why these doctors might not recommended or, again, if it's a timing issue or duck might be like, I don't know, what even to tell you now, where, you know, what are what are even some of the communication pieces that a provider could give to a patient to not only educate them about what potentially is available, like you are available, or different things are available, but but, but why they may kind of brush off, not really brush off, but just not be saying, let's go get an MRI for your headache, or whatever it might be. Yeah,

Unknown Speaker  8:18  
yeah. I think, you know, I think a big piece of it, you know, and I, I hear more from patients than I do from other practitioners, but from the patient. And I do think that that really open and honest communication is a huge piece of the puzzle. You know, being honest with your patient about what your restrictions are, or being honest with a really complex patient that you haven't ever seen this particular combination of symptoms before. So maybe you need to dive in and do some research for them, you know, to either brush up on what's going on with them or, you know, figure out what's going on with them. And I think it's okay to admit that you're hemmed in by insurance, you know, requirements. And I also think it's okay to tell your patient that you don't know all the answers. And that way, when you say like, you know, you tell them I don't maybe you wouldn't say it like this, but you tell them I don't know what to do with this symptom. They know that you're on their side, instead of hearing. I don't know what to do with that symptom Now go away.

Julie Soukup 9:26  
Yeah, yeah. Yeah. That's interesting, because they it goes back into that team mindset. You know, we had this pediatrician on our podcast last week, who was talking even about the physical nature of making sure a parent and a and a patient, always understanding they're on their side as well. It's sitting next to them saying hey, because he had some that were more chronic illness with an ear, nose and throat and saying, Hey, I'm in this journey with you throughout this whole space. And so similar kind of in that is like, you know, I may not have I have all the answers, but this is what I know. And this is why I'm confused or not sure. If especially when, because I would think even for a physician, it's hard to, if you're not knowing those answers, you're, you're like, you know, me mentally I'm like, I go to a doctor, they should know everything like, like, way too many things out, even outside of medicine, you know, it's that perception, that white coat perception that they can just know it all. And what you're saying is kind of taking that step back and just be like, hey, like, I'm human, let's talk about our limitations and why why I'm not seeing this or why not understanding or why I'm not recommending that, you know?

Unknown Speaker  10:39  
Yeah. And I think I think that's good, especially with with a pediatrician was coming from is having that patient practitioner, the patient, yeah, patient practitioner relationship as a partnership. And, you know, traditionally, classically with gaslighting, it's like, it's like a power play, which might be true for some practitioners, but I don't think that's the case for most practitioners. And, and I think, when you're honest with your patients to in more of a partnership, rather than like a parent child kind of relationship, yeah, they do recognize that you're human. And you don't have all the answers, but but you're working with them. And you're working for that. And better. Yeah. And so what other

Julie Soukup 11:21  
like tips, would you say it's like a provider's like, Okay, I do see myself kind of having more of this role, or kind of, not intentionally, but dismissing these things or things along those lines. I mean, if you were going to kind of say, Hey, these are some tips that I would really recommend, so that a patient's not perceiving it as gaslighting as it perceiving it as that being, you know, dismissed. What would be some things that you'd really suggest?

Unknown Speaker  11:47  
Okay, I have a bunch of suggestions. I thought about this a lot. So, and I thought about, you know, what do patients bring to me about other practitioners and of course, I always take what patients say with a grain of salt, because sometimes they don't feel well. And their perception isn't 100% Spot on. But I think one of the most common things that patients will sort of complain to me about is, like, in the last maybe five to eight years, is practitioners just having their head in their keyboard and typing and not connecting to them connect. Yeah, like that eye contact? Yeah. And it's probably worse in the last couple years, because so you know, we're doing so much more telemedicine now. Yeah, even harder to connect. So if you're not making that connection, a lot of times, it's really hard for the patient to feel heard. So I think, for practitioners on a practical level, if you are terrible at typing, and you have to look at your keyboard, maybe take a typing class, so you can type while you're looking at. Yeah, yeah. Which I never had been as grateful for my typing class in high school as I am now. Because I can type and look at my patient. And I think that,

Julie Soukup 13:00  
that, yeah, that, that that connection, you know.

Unknown Speaker  13:06  
And I think another way, we can, you know, not guess, like patients is, you know, I still with female patients who are a larger portion of the patient population to be gaslit. Because, you know, kind of historically we see female patients, not maybe not consciously but you know, as being hysterical and dramatizing their symptoms, when maybe, but I see a lot of women get blown off and told your symptoms or because your hormones, okay. And maybe that's the case, but, you know, if they're having symptoms, because of something like hormones, you know, dig in and do a little more investigation. I think the same applies with the whole getting older thing. I have had a patient who, who was told to stop running because her knee hurt, and she was just getting older, you know, but I ordered imaging for her and she had a meniscal tear. So you know, there's something going wrong, it wasn't just getting older. So getting the time in the space to do that investigation for your patients is important.

Julie Soukup 14:13  
And it's so interesting, you said that because that was one thing that really caught me when you and I had our first conversation is, you know, that it being in a profession that you chose and the type of medical specialty that you chose, there's really a lot of association with the mind and the body and and that it does take that extra bit. I think you even had said compassion to really like, truly listen and really like kind of hear and pull out from the patient to be able to investigate these symptoms further. So some of the things they may kind of say are less. You know, like, wait a minute, wait, tell me more about that. And how many of the and I thought it was interesting. You're like I just get to really hear hear somebody out especially when they've kind of Have you been told, Oh, you're just getting older? Oh, well, you're just a circle woman with hormones, you know, like, oh, it's postpartum, you know, whatever. And you're just like, well, what is the association of mind body when you are looking at holistically? And then that being said, is, let's really talk through, you know, and identify these and investigate you said the symptoms.

Unknown Speaker  15:21  
Yeah. And it can be tough to sort of tease that apart. I mean, I think, you know, I've been in practice for a little over 15 years, and a big part of my practice, you know, historically has been people who have chronic illness and chronic pain. And I think, I think in those instances, we, we especially see that connection, that mind body connection. And it's, it's a skill to hone to really be able to, you know, to see what, what are symptoms that you can work up and like, quantify? And then what do you need to maybe refer out for, you know, another type of, you know, another type modality of treatment, whether that's therapy or have a whole list of them, you know, meditation, can they do yoga? Can they do clinical hypnotherapy to sort of, you know, move these, you know, because we all know it's connected. And so they might need more, they might not just need drugs or surgery, they might need one of these other modalities to sort of help the mental connection. But without putting across the message that the practitioner thinks they're crazy, right? Definitely, when

Julie Soukup  16:40  
it also comes to like a question of even ownership, like, if I have, like, I'm doing everything I can, and I'm trying to kind of make me do some of these other practices, you know, like meditation or, you know, some of the water therapies that they do that at least now I am still becoming an active participant and owner and my own health, where I think that that kind of goes when you are having these symptoms, or these things that are just not quite making sense and not aligning is well, how do you there's got to be an element of like, hopelessness that these patients will have, like, why don't you know what to do? Like, give me another medication, give me another surgery, where you're kind of like, well, actually, like, let's kind of address both of these issues, especially when we think about anxiety or stress, and what those can do to your health, you know, which is all mine, you know, but you know, it's interesting, like that power that you kind of get back then. And yeah,

Unknown Speaker  17:36  
it's not that kind of thing is super empowering for the patient, which is in the more we can get the patient to buy in and be a partner, you know, a true partner in that relationship, the better they're going to be in the you know, I think everyone's happier in that scenario. Because I know when you have a patient who just like, has raging diabetes, but won't stop eating pie like that gets frustrating. So if you can get them to buy in and make some changes, and take some positive steps towards your own health, it really does benefit everyone.

Julie Soukup 18:06  
Yeah, absolutely. So one of the things I think that has evolved aggressively, of course, we know with COVID is the use of technology, the use of you know, doing visits virtually, and this capacity, even medical memory that's now using these visits to record these cases. And these doctors, especially in a consultative space, where you might get a lot more information that's beyond kind of their scope. How have you, what are your thoughts about how that really can impact a naturopathic approach to communication? Um, in both of those ways? Or does that have to become more challenging? Because a lot of these visits might be more virtual at first? What are kind of like, how are you? What are your thoughts on that?

Unknown Speaker  18:53  
Yeah, I'm recording, I think that, you know, I think a couple things, a couple of huge benefits of having the recorded visits. I think, first of all, you know, it can allow the patient to go back and watch the visit, or even have somebody, you know, their partner or parent or whoever wants to visit with them. So that they, you know, sometimes when patients are in the office visit, they're freaked out, or they're nervous that they're at the doctor, and they're not really hearing what the practitioner is saying. Yeah. So if they get a chance to take that step back and get a little space, you know, they can they can get a more maybe a more accurate idea of what the practitioner, you know, was intending with that visit. And they didn't actually say this, they actually said this other thing, but they, they just heard it wrong. So I think, like having that recorded recall can be really valuable for the patient. And I think for practitioners to like when I look at patient advocates, The websites and stuff, bringing, you know, bringing another person to a visit can really cut down on medical gaslighting. And so, to me that that what that tells me is that some accountability for the practitioner, you know, helps them watch themselves a little bit better, because most medical gaslighting happens when the patient that practitioner alone. So, you know, recording the visit is another sort of piece of it's almost like having another person in the room, right? So that bit of accountability might help the practitioner check themselves if you're kind of getting into that space where the patient's annoying, and like, I just need to move on with my day. Yeah,

Julie Soukup 20:41  
and take that extra little bit of, Am I really taking that extra time to make eye contact and investigate kind of those those pieces? Now, why did they are saying that that I mean, and recording definitely is allows, especially with COVID. And those restrictions are available, does allow family members have access to it and somebody else to kind of be a medium for a patient to best understand these things. But why we're Why do you think that a person just in the room in and of itself helps minimize like medical gaslighting? Is it because they get louder than the patient? Or they heard it too? Like what why do you think that is?

Unknown Speaker  21:18  
That's a good question. I hadn't thought about it that way. Mmm hmm. I think the dynamics just the dynamic shift, I think, you know, practitioner patient, yeah, brings that dynamic a little bit closer. And I never I almost I rarely think the practitioner when patients tell me, I rarely think they're trying to be like me on purpose. But I do think it probably gives that practitioner a little bit of pause, and maybe makes them think about what they're sounding like not just to their patient, but to that person who's not directly in that one to one relationship,

Julie Soukup 21:55  
for sure. And I think that that's kind of maybe where a patient's perception of gaslighting or a patient's perception of they just dismiss me they're not seeing also on the other side, a clinic that is just way beyond packed to capacity that nurses are overstretched, doctors are over stretched, and they're top trying to do the most that they can with the time that they have. And, you know, sometimes I think, even you know, there's, that's where I think some of the tips that you mentioned, of making sure you're being really transparent about, you know, why these things are being recommended, or these things are or why different specialties should be potentially introduced. Versus just saying it like quickly or old, no, that doesn't make sense. Even that little time, there would have a huge impact on a patient's perception of doctor, it might be doing this, when really they're not. They're just overburden and older, you know, understaffed and just try and do the best with the time that they have.

Unknown Speaker  22:54  
I totally agree. And I'm struggling straight up with patients, I'm like, you know, what, I've got a staff member out sick. And so in my nurse is on vacation, I might need to leave to discontinue my this patient's ID or I might be running a little behind because I'm short staffed today, you know, we try to, we try to communicate a lot with our patients about things like that. So they said that they don't get frustrated with us and think that we're out taking care of them when really we're just doing our best.

Julie Soukup  23:22  
Right? Right, we're all just trying to do our best or I'm just like, you know, people at the end of the day that have had, you know, people call it sick or and things that are kind of happening and, and kind of, as you said before, it shifts that dynamic from like a parent, you know, Kid relationship, or I know more than you relationships really like let's really talk these through investigate these things have the compassion to like, look at it side by side, kind of to move forward and that capacity. And so as far as then with with, you know, that being kind of said, you mentioned a few of these more of the things that a doctor could do. And it sounded like you had a few other ideas. One was like, definitely, you know, be aware of what you're doing with your hands if you need to practice those things so that you can maintain that eye contact was a great one. But what are what are kind of a few other things that can kind of lead some of our providers, especially in really busy clinics, to make sure that they're not being perceived as that even even when they're not and they're not, that's not their personality, but that a patient isn't perceiving that.

Unknown Speaker  24:25  
Yeah. So I think I'm like, ooh, I've got some good ones here. So I think one thing that, okay, so a chronically ill patient, if they've been chronically ill or in pain for a long time. Sometimes they can come across really strong. Yeah, and maybe even a little aggressively. And so I think it's important if a patient disagrees with the practitioner, or is asking a ton of questions, not to take that personally. They're not like testing your knowledge. They just really have questions. Yeah. So I think It's easy to get into a headspace where if a patient is asking a ton of questions, or they're not just following what you want to say, to get frustrated with them, and then kind of want to brush them aside a bit. But I think usually, in my experience, it's been the patients that ask a ton of questions, once they understand where the treatments going, they're super compliant they're willing to learn. Right? Right. Yeah, being able to kind of weather that storm is a good one.

Unknown Speaker  25:29  
I've not been as challenging and more like, I just am really trying to over educate myself.

Unknown Speaker  25:33  
Yeah, yeah. Yeah. Yeah.

Julie Soukup  25:37  
Especially when things aren't aligning. I could see that too, you know?

Unknown Speaker  25:41  
Yeah, yeah. And there's a fine line. Like, I know, there can be patients who I don't. And I think most of the time, they're not intentionally doing this, but they come across as like, Hey, I Googled this a bunch. And now. And now, I'm going to question everything you say, you know, y'all hear about Dr. Google, you know, kind of laughing? Yeah. But they're really just desperate for answers.

Julie Soukup 26:06  
That's it for understanding this refer? Yeah, knowing more. And after I think even that video comes into play, really, you know, solidly to is that, um, that they can go back and even reference those answers. So even if they're in the question, like, are you really hearing what I don't answer what you asked, like, are you really hearing the answer? And so having even like, those resources of video, or even content the providers have made, it's not just always paper to be able to be like, Okay, now I know, like, okay, they didn't answer that. And I can relook at it, because it's just too much in the time period that they have available. Yeah. That's interesting. What other one kind of give us one last one. I'm here. Okay. Let me check.

Unknown Speaker  26:48  
I think I know the one I want. Okay. Gosh, so I think I think the most important one would be if you kind of can't figure a patient out. I think letting them know that you can't figure them out. And you're going to send them somewhere else to somebody who maybe has more experience with that condition or something, to get a second opinion about what's going on. Is important patients appreciate it. Most of the time, they're like, Oh, you actually recognize that you've kind of maxed your knowledge out. Yeah. And it's, you know, you need to send me to someone else. Yeah. And that, that's pretty validating for them, you know, they they feel heard, and they feel they still feel like you're on their side.

Julie Soukup  27:36  
Yeah. And so always kind of that having that referral basis of Who do I know, they may just even perceive this a little different than me or be more holistic in your perspective, like in what you're doing? Or, you know, you know, whatever my referrals matches the people that I know, that kind of thing Do I think, but kind of here's some different things that you may, you know, want to try out or look into, just because I've hit capacity. Am I really? Like, yeah,

Unknown Speaker  28:05  
do you have that acupuncturist, you know, in your community that's really good with pain, or, like, I get a lot of the people who have had three surgeries, and they still have pain, or they have a collection of symptoms, and really what they have going on is a chronic, you know, epstein barr, or Lyme disease infection that, you know, isn't quite in the, in the box of conventional medicine. Yeah, sure. Sure. No, that's

Julie Soukup  28:29  
great. I mean, and and as you said, is it validates a patient's ability to just say, like, okay, you know, I am feeling heard I, I can look at more information, especially even if they're recording most of these, they could pass that along, like the other guy had said, and had expressed medical memory work a lot of times with hospitalists, where they will record, you know, and it's a big complex more thing, sometimes even symptoms are louder, but being able to make sure that everybody's on the same page, including some of the providers and the patient about the bigger scope of some of those stuff. Even on smaller symptoms, I could see that being helpful. And having that document in that record, like where are we going? And why to be able to refer back to your ABA specialist even refer back to the Great, that's a great thing of you know, who in your community is doing it a little differently than how you're doing it? You know? Absolutely. Well, that's great. And I think that you're shining a light on something that you know, I get I only I think gas lighting just in general became something that is more common knowledge in the past few years. And that's what I was like really interested in is, you know, how do we how do we support our doctors to make sure that that's not coming across with the kind of the tips that you provided, just making sure you know, all those little things of even if you don't have the time, like, here's my referral if you don't mind making sure you have eye contact or ask those few other questions, just to kind of buy in so I really appreciate your time. In your intellect, in the space, I know I have learned a lot already engaging you and looking at kind of what you do, and your medicine space have, and something's not as familiar for me, you know, or my dad is in that space, he's got a ton of pain, he's had a couple surgery, we got to start looking at other options that are just beyond, you know, constant surgeries and moving forward. So I think that provides so much of a more robust picture of what what is available. So thank you for that and for taking the time with us today. To add, no, I

Unknown Speaker  30:35  
don't think so. Thank you for having me today. I really appreciate it. And and I think what I might do is end up writing a little article or blog post and put it on SlideShare on his website that way if there's anything I didn't get to today that I made notes on, people can have access to that.

Julie Soukup  30:51  
Yeah, absolutely. And that's and your website is just that WW dot sage Sirona. Calm. Yeah, awesome. So it's a great resource, then to kind of go for more information for a patient or a provider to kind of see about about this, you know, this space, so awesome. Well, thank you so much for joining. And I look forward to kind of like continuing to follow you on Instagram and learning, you know, learning more about you in this space. So thanks again so much. Thank you.

Transcribed by https://otter.ai