Finding Migraine Care: Cultural Humility and Medical Gaslighting

Medically Reviewed By Meredith Goodwin, MD, FAAFP
Jaime Sanders_Finding Migraine Care Cultural Humility and Medical Gaslighting

One thing I’ve experienced over the last 20 years of navigating the healthcare system is that many healthcare professionals have made me feel as though I am responsible for the progression of my migraine disease. As a child, I wished I had asthma like my sisters instead of migraine, because everyone else took them more seriously. In my case, I felt blamed for why I was still having migraine attacks.

Having your symptoms dismissed or ignored by a healthcare professional is known as medical gaslighting. It can be devastating to mental health and frustrating to continue trying to find relief.

“Are you doing everything you can to get better?”

One particular summer, I was experiencing long and painful migraine attacks that were not responding to my acute and rescue treatments at home. It was my third time in urgent care in a month, and I happened to see the same physician as the prior two visits. Whenever I require a trip to urgent care or the emergency department, I bring a binder that houses all my medical information and the treatment protocol I need to break the attack.

This physician was not very kind to me and was visibly annoyed that I was there for a third time. I honestly did not want to be there because she had been so horrible to me before, and I was extremely anxious that she would be on call that night. When she walked into the room, she first said, “Oh, the binder.” This physician dismissed and disrespected me without even acknowledging me. She had reduced me to an object; she used what I needed to validate my disease to mock me.

I immediately regretted going there. This physician’s reaction still causes immense anxiety whenever I seek emergency care for migraine. The doctor asked me why I was back and if I was doing everything possible to not wind up in urgent care so many times. Her tone was condescending and abrupt, which I took great offense to. Here I was, in excruciating pain, seeking treatment, and I had to convince this physician that I was receiving the appropriate care for my disease.

It wasn’t until I explained every treatment, complementary therapy, and out-of-pocket expense I had utilized over a decade that she snatched my binder out of my hand and ordered the medications I needed to break the migraine. The entire experience was humiliating and dehumanizing. After that, I refused to return to the urgent care center for fear of being treated the same way again.

The harm in blaming patients

I expect kindness, empathy, and respect from the healthcare professionals I encounter on my treatment journey. With migraine, that has not always been my experience. As a Black woman, I am also painfully aware that my race and gender influence the dynamic of the doctor-patient relationship. The amount of blame put on me for why I am still in pain is cruel and harmful.

One of my neurologists said that I rely too much on medications and that his other migraine patients have their pain controlled through lifestyle modifications, implying that I am lazy and unwilling to do what is necessary to get better. The lack of education on headache disorders among healthcare professionals has fostered a culture of blaming patients for the severity of their disease. It feels overwhelming sometimes to have to continue to advocate for myself despite these challenges.

I’ve learned firsthand that migraine comes with implicit bias that adversely affects patients and their care. Doctors blaming me for my pain and making me feel responsible for having a disease I did not ask for has been harmful to my mental health and overall well-being. Clinicians that carry biases about migraine and unconscious biases about race, gender, culture, and religion create an unhealthy environment for their patients, and I’ve heard similar experiences from others in my migraine community.

The importance of cultural humility in healthcare

Part of medical gaslighting includes the lack of cultural competency on the part of doctors. Cultural competency recognizes and respects cultural differences in health behaviors. Today, I prioritize finding doctors who take the time to consider my particular beliefs and actions rather than seeking to place me under a cultural label.

Promoting humility – knowing how people's cultures influence health behaviors – supports cultural competency. I’ve seen how using this insight builds sensitive approaches to treating patients. In my advocacy work, I’ve learned that teaching cultural humility and cultural competence in medical school helps students understand potential power imbalances between doctors and patients. I want all medical students to be exposed to these concepts so eventually, no one has to have the same experiences that I’ve had over the years.

Thanks to many researchers, we know that a lack of awareness of cultural perceptions raises the possibility of clinicians subconsciously imposing their beliefs on patients. If the clinicians that treated me were culturally sensitive and had not brought their prejudices, assumptions, and views into the examination room and actively listened to me, my interactions with them would have been more positive.

Humility shapes clinicians' perceptions of themselves and others, influencing their approach to medical practice. Physicians I see with cultural humility show their understanding in their curiosity, desire to care for others, and interactions with team members and patients. It’s an awful feeling to not feel believed or understood by your doctors. I hope more healthcare professionals become aware of this problem, and that more people with migraine can have positive, compassionate experiences. I’m grateful to have found doctors who do see me for who I am and not for the label they could assign me, and I want more people to be able to find that, too.

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Medical Reviewer: Meredith Goodwin, MD, FAAFP
Last Review Date: 2023 May 11
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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.