this post was submitted on 19 Sep 2023
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The problem is the complete dismissal of subjective evidence as being a valid form of evidence. We have deified objective evidence to the point of hubris, denying the existence of anything that doesn't show up easily using our current technology. In my experience, it's less often gaslighting and more often an embarrassing lack of epistemological humility and a pretense that we are have somehow reached the pinnacle of medical technology already and have nothing left to learn.
We're here to treat patients, not test results. If a patient is reporting that they are experiencing distressing symptoms or that something is making them feel better or worse, they deserve to be taken at their word. Ignoring them because our current tests are not sophisticated enough to identify everything invalidates their subjective experience, and that's not patient centered care.
This is the real issue when people are talking about medical gaslighting. Every endometriosis patient being told for years on end that their debilitating symptoms are "normal" period pain. The embarrassing statistics on how long it takes someone with an autoimmune disease to be correctly diagnosed.
We've become too impressed with our technological toys and forgot how to see the real human beings in front of us.
I won't say every doctor is innocent of ignoring legitimate concerns they hear from patients but your argument is missing context. Subjective symptoms from a new patient or one I know doesn't fret over every somatic sensation they get in their body? Sure, I'm looking into that deeper. Coming from my known anxious, health obsessed patient who wants evening done all the time? Nope, that's a conversation and possibly some blood work just in case/to reassure. I can't give everyone a million dollar workup, it's inefficient use of resources and usually unwarranted. You have to listen to your patients, they give you a lot of useful information, but you have also have to be healthily skeptical at the same time.
Yes, but that's different from subjective evidence and I think that's part of the problem. There's a difference between somatic symptoms and subjective evidence.
We differentiate between the two all the time without explicitly identifying it as such. "Patient says the feel a lot better this morning" vs. "patient says they still feel rotten" is valid subjective evidence that we really do take under consideration when evaluating treatment response.
Onset, duration, aggravating and alleviating factors, and consistency of reported symptoms are all things that distinguish evidentiary subjective reports from somatic ones. I've walked psychotic patients through things that were distressing to them that I knew were somatic. And I've caught "real" things where the patient subjective report was really the only indication we had. It IS possible to differentiate.
Granted, this demands more time than the corporations we work for would like to permit us to spend with our patients. Which is a huge part of the problem that we should all be protesting.