The doctors are not OK. by K. Johnstone, June 3

[southwestforests]

A lot of us have already seen and suffered effects of this.

The doctors are not OK.
Shame, medical training, gaslighting, and cycles of abuse.
K. Johnstone
Jun 03, 2025

https://mecfs.substack.com/p/the-doctors-are-not-ok

A few days ago I listened to a wonderful podcast, Long Covid MD podcast #50: Ask The Patient - Why Medicine Still Doesn't Listen, with Dr Zed Zha. In it, Dr Zha told a story about her time as a medical student working in a hospital. A senior doctor asked a question and the student replied honestly: "I don't know". The senior doctor responded by humiliating the student, and later wrote in the student’s assessment that she was not fit to work in that particular area of medicine.

Dr Zha recalled feeling intensely ashamed in that moment. The feelings of being shamed were deeply upsetting, even traumatic, and it seems that this experience of being shamed was a common one in medical training. It was even noted that medical training is based on shame.

I was struck by how unfair it was that the student was punished for saying "I don't know". It's not just that she was shamed; a possible avenue for her future medical career was cut off. The other students may not have known the answer either, but they kept quiet about it; by hiding the gap in their knowledge, they gained an advantage over the honest student.

I think this story explains a great deal about the way doctors behave.

For one thing, this story shows that medical training is deeply dysfunctional. The student who spoke up and said "I don't know" was behaving correctly. She was taking responsibility for her own learning by acknowledging a gap in her knowledge and inviting the senior doctor to teach her what she needed to know. This is how people behave in a system that is working well.

By shaming the student for not knowing, the senior doctor taught the students to hide gaps in their knowledge. In the future, if these students didn't know the answer to a question, they would do anything to avoid admitting it; they would avoid the question, change the subject, or pretend they thought they'd been asked a different question and answer that one instead - anything to avoid saying "I don't know." By hiding gaps in their knowledge, they would close off opportunities to learn.

Apart from being a terrible way to train people, I think this dysfunctional style of teaching may explain why so many doctors, whenever they encounter a patient whose symptoms they don't understand, immediately and confidently declare that the patient is simply "anxious," or lying, or exaggerating, or crazy.

On the surface, this behaviour makes no sense. It’s bizarre. It’s actually very childish. These doctors behave as if anything they don’t understand simply doesn’t exist, like a child who covers her head with a blanket and thinks the world is no longer there because she can’t see it.

It's obvious that no doctor can know all there is to know about medicine; medical knowledge is far too vast for that. And it's not just the rare conditions where doctors lack knowledge. The list of common and serious conditions that are barely mentioned in medical training - for instance: long Covid, ME/CFS, Sjogren's syndrome, Ehlers Danlos syndrome, POTS, mast cell activation syndrome and chronic lyme disease - goes on and on.

But the bizarre assumption doctors make - that any medical condition they don't understand simply doesn't exist - does make sense when you consider that in medical school they were taught that it's really unacceptable not to know something. They spent years being forced to behave as if they knew everything. If you repeat the same lie over and over, it begins to sound true. Maybe some doctors have pretended to know everything for so long that they actually believe it.

And, whether a doctor truly believes they know everything or not, it's easy to see how an inability to say "I don't know" can lead directly to medical gaslighting. A doctor who is faced with a patient whose symptoms they don't understand, and who has been psychologically brutalized into having a pathological inability to say "I don't know", might really feel they have no choice other than to dismiss and gaslight the patient.

The doctors are really not OK.

You could see medical gaslighting as a cycle of abuse, a case of victims of abuse becoming abusers themselves. Medical students are held to impossible standards, shamed, and gaslit into believing that they can and should know everything there is to know about medicine. Once they become doctors they abuse their patients in turn: they dismiss the patients, tell them their lived experiences are not real, and behave as if patients are liars and fools whose testimony about their own lives and their own bodies cannot be trusted. It's a case of the biggest monkey hitting a smaller one, who then hits an even an smaller monkey, and so on.

I have no idea what patients can do about all this. My favourite moment in the podcast was when Dr Zha was asked what patients can do to better advocate for themselves, and she replied that patients already advocate as hard as they can - it's up to doctors to stop putting up so many barriers. I loved this. Patients really can't do anything about the profound dysfunction in medical training, doctors are the only ones who have any power to change this. By talking about these issues, which I think are rarely discussed, Dr Khan and Dr Zha did take a small step toward addressing these problems.

While I can't really do anything about systemic problems in the medical training system, I found that thinking about the reasons why doctors gaslight their patients did help me deal with my own medical trauma. For me, one thing that has made it very hard to recover from medical gaslighting is that in the past I had a tremendous respect for the medical profession (and to some extent I still do). I believed that doctors were highly trained professionals whose clinical practice was based on rigorous science. (I now know that this is sometimes true, but often very much not the case - medical practice is often driven by prejudice, ingrained bad habits, bad science, and propaganda from governments, pharmaceutical corporations, or insurance companies.) My misguided respect for the medical profession made it hard for me to shake off the idea that the repeated medical gaslighting I endured was somehow “my fault”.

It helps me to realise that when doctors gaslight their patients, the doctors are themselves survivors of psychological abuse who are having a knee-jerk reaction to their own trauma. Their behaviour has nothing to do with medical science, and it has nothing to do with good medical practice. These doctors are not OK. They need help, although they’re unlikely to get it. The doctors who dismissed and gaslit me over and over do not deserve my respect. They deserve sympathy. They deserve pity. But not respect.

 

[Rufous McKinney]

All this led me to considering the ongoing Sleep deprivation component of Medical School. I read all that is still happening. Disrespecting sleep requirements of the human body is their training, then we expect them to be helpful and concerned regarding our Non Refreshing Sleep and related toxic effects.


Meanwhile, what is the "correct" answer in the case above?

If you "do not know the answer"...was the student supposed to just guess? is guessing better?

I wonder what they suggest doctors or Med Students say, when they do not know the answer.

In my experience, the doctor does not really answer the question you ask them, anyway. I always leave with a large empty void where their Answer was supposed to get recorded.

 

[southwestforests]

All this led me to considering the ongoing Sleep deprivation component of Medical School.

The American Medical Association appears to want doctors to be sleep deprived, there is less "We need to change the system" and rather more, "Here's a way to cope with a system that we know is broken".


Medical Resident Wellness
Use these strategies to manage sleep deprivation in residency
By Brendan Murphy, Senior News Writer
Nov 21, 2024 | 5 Min Read

https://www.ama-assn.org/medical-re...strategies-manage-sleep-deprivation-residency

 

[Viala]

I think it's because most of what we know as contemporary medicine simply doesn't work. Not everything, obviously, but a lot of it. Students asking questions or saying they don't know something are inconvenient. So they are traumatized, sleep deprived during their education and later during residency, also desensitized and empathy deprived, that's part of that too. If they are too tired to think and to feel for sick people, they eventually stop thinking and just do what they're told. Then after 10 years of this they just want their prize, they do not care anymore if what they've learned is true. They want what they've worked for.

But we cannot excuse abusers. They do not deserve sympathy nor pity. They are adults in the position of power, and they still continue to abuse people who are at their mercy. Patients deserve sympathy, not people who make money from their misery, fully conscious of what they're doing. They at least got something from their trauma, they have respect, status and money, wide safety net, large houses, cars and vacation wherever they like. It sounds like corruption to me. Patients have bills, trauma and sickness.

 

[southwestforests]

It sounds like corruption to me.

The rest of the family used to dismiss Grandfather W's assertion of corruption in the American medical industrial complex.
If he was still living I'd have to relate some of my experiences.
True, some of my experiences have been good,
but there remains that number which do not appear to contradict his assertion.

 

[Viala]

This article reminded me that a few years ago someone on this forum posted a link to a guideline for UK doctors on how to talk to patients when a doc doesn't know the medical cause. It was an unofficial document, but looked real, and it was basically 101 on manipulation and how to gaslight patients when they say something against the grain, it was deleted soon after. High quality, someone who put it together knew what they were doing.

It basically said what's in this article here, never admit that you don't know something, diseases that we don't know are a threat to our medical system, push the agenda that it's psychosomatic etc. I wonder if it's still online somewhere because that would be a big deal if some journalist would like to look into it.