Experiences of Patient Incivility: A Qualitative Study

We didn't start the fire…or did we?-a narrative review of medical gaslighting and introduction to medical invalidation

Background and Objective

Gaslighting is defined as behaviors inflicted on an individual which invalidate or call into question their ability to judge their own lived experience. Research into gaslighting in other contexts, such as domestic violence, underscore its potentially damaging effects. Medical gaslighting is an increasingly used, but poorly defined issue in a progressively more complex healthcare system in the United States. Limited studies constructively evaluate this breakdown in the provider-patient relationship and no studies exist evaluating gaslighting in the care of patients with digestive diseases. This narrative review aims to add clarity to the definition of medical gaslighting, evaluate the mechanisms that perpetuate gaslighting in gastroenterology practice and offer pragmatic solutions to begin to reduce its prevalence.

Methods

Narrative overview of the literature retrieved from searches of computerized databases.

Key Content and Findings

The potential root causes of gaslighting in gastroenterology practices are multifaceted and complex, and encompass patient, provider, and systemic factors.

Conclusions

An important distinction for medical gaslighting from other forms of gaslighting is the role of intent. As such, we propose the term "medical invalidation" be added to this construct and conceptualize medical gaslighting as occurring on a continuum. Within each facet of the relationship between system, provider and patient there are opportunities to prevent and recover from the occurrence of medical invalidation/medical gaslighting.

Capturing women's voices: lived experiences of incivility during childbirth in the United States

Increasing research has improved global awareness of mistreatment during childbirth. However, research primarily focuses on "higher-intensity" mistreatment during childbirth, and largely focuses on women outside the United States (U.S.). We address these gaps by exploring the phenomenology of incivility, a "lower-intensity" mistreatment, experienced by women during childbirth in the U.S. We used a combination of interpretative phenomenological analysis (IPA) and thematic analysis to analyze the qualitative responses (N = 200) of experiences of incivility during childbirth. We identified nine primary themes of incivility: lack of empathy, denial/minimization, ignoring, pressure, privacy issues, breastfeeding/formula issues, identity-based, uncomfortable physical interactions, and silencing. Results demonstrate incivility is critical to consider as a form of mistreatment in childbirth because it violates respect. The results help nuance the understanding of how mistreatment is experienced in childbirth. Results also demonstrate unique manifestations of incivility were shaped by the sociopolitical context of the U.S. Implications for policy development and health outcomes are discussed.

Witnessed Incivility and Perceptions of Patients and Visitors in Hospitals

Research has examined instances of incivility witnessed by physicians, nurses, or employees in hospitals. Although patients and visitors are members in hospitals, witnessed incivility from their perspective has rarely been empirically investigated. The aims of the current study are 2-fold: (1) to investigate the forms of incivility patients/visitors witness in hospitals and (2) to examine whether these patients/visitors believe these incivilities impact the target’s sense of perceived control. An integration of interpretative phenomenological analysis and thematic analysis was used to code qualitative data (N = 77). Eight themes of witnessed incivility and 3 themes for impact on perceived control were identified. The results illuminate patterns of incivility targeted at marginalized groups, historically underrepresented in hospital-focused incivility research (eg, homeless individuals, incarcerated individuals, the elderly individuals). The majority of witnesses believed the incident of incivility would negatively impact the target’s perception of control, possibly affecting their experience and health. The current study demonstrates that empirically investigating witnessed incivility from the patient/visitor perspective provides critical information about the unique patterns of mistreatment occurring within hospital contexts.