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.