Table of Contents
Key Timestamps:
- 01:30 — Dr. E's origin story, her wife's autoimmune diagnosis and the "quack" who changed everything
- 06:45 — What medical gaslighting actually is
- 11:00 — Gaslighting yourself: trusting labs over your own body
- 13:35 — The concept of "pre-disease"
- 18:55 — The labs Dr. E would rethink (TSH, A1C)
- 20:20 — Normal vs. optimal
- 22:15 — Intuition vs. pattern recognition (the pilot/firefighter comparison)
- 25:20 — Why you need a healthcare team, not just one doctor
- 28:05 — Why some patients get angry learning options exist outside insurance
- 31:35 — Menopause-specific gaslighting and HRT dismissal
- 33:15 — The "I don't have tools" reframe
- 33:40 — How to talk to your doctor so they actually listen
- 37:40 — The one question to ask before you leave the exam room
- 41:00 — The colonoscopy story: why "normal for your age" matters
- 42:30 — Final advice: be the CEO of your own health
- 44:00 — Where to find Dr. E
What Is Medical Gaslighting, Really?
If you've ever left a doctor's office feeling brushed off, you already know the feeling even if you didn't have a word for it. Medical gaslighting is what happens when your symptoms are real, but the tools in front of your provider can't explain them, so the conversation ends with "you're fine."
Here's the girlfriend-to-girlfriend truth from my conversation with nurse practitioner Dr. Efrat LaMandre, known online as Dr. E: most of the time, this isn't malicious. It's not a doctor deciding you don't matter. It's a doctor who has genuinely run every test they know how to run, and come up empty. As Dr. E put it, that experience "is generally speaking a result of indoctrination among the doctors, but also from the patients." Both sides have been trained into roles that don't leave much room for "I don't know, let's keep looking."
That distinction matters, because it changes what you do next. You're not fighting a villain. You're working around a limited toolbox.
The Line That Changes Everything: "I Ran Out of Tools"
This is the reframe I want every one of you to carry into your next appointment. When your provider says "everything looks normal" or "I think this is anxiety," what they usually mean is: I don't have any more tools for this.
Dr. E said it plainly: when a doctor tells you you're fine after a full workup, "what you need to hear is, I don't have tools. That's what this doctor is saying." Not "there's nothing wrong with you." Not "you're making this up." Just, I've hit the edge of what I know how to do for you.
Once you hear it that way, you stop taking it personally, and you start knowing exactly what to do instead: say thank you, and go find someone whose toolbox is different.
Normal vs. Optimal: Why Your Labs Can Lie
Here's something I say often, and Dr. E and I riffed on it together. Normal is a population average. It's not a personal goal.
Think about it this way: if you stood outside a busy store and watched people walk in and out, most of them would look "normal." Average energy, average health, average complaints. But average America right now isn't exactly a picture of vibrant health. Do you want to be the 8 out of 10 who's just getting by? Or the 1 or 2 who's genuinely thriving?
Dr. E made the same point from the lab side. Standard bloodwork like TSH and A1C are, in her words, "late stage findings." By the time your thyroid numbers move, you've likely had symptoms brewing for a long time. By the time your A1C shifts, insulin resistance has often been building for years. Being "all in the green" isn't proof that everything is well. It's proof that nothing has gotten bad enough yet to show up on a basic panel.
What Is "Pre-Disease" and Why Doesn't Anyone Treat It?
We all understand prediabetes. There's a test, a name, a way to track it. But Dr. E points out that almost every chronic condition has its own quiet "pre" stage, brain fog before dementia, fatigue before autoimmune flares, and most of the time there's no test, no name, and no plan for it.
That's the gap where so many women get stuck. You don't feel like yourself, but you're not sick enough yet to fit a diagnosis code. Your provider's honest answer is often "let's watch it," because the system is built to treat disease, not to catch the years leading up to it.
This is exactly why prevention-minded care matters so much heading into perimenopause and menopause. You don't have to wait for a diagnosis to start supporting your hormones, your microbiome, and your metabolic health.
Your Intuition Isn't Drama, It's Pattern Recognition
One of my favorite moments in this conversation. Dr. E pointed out that when a pilot or a firefighter senses something is wrong before they can prove it, we call that instinct and put them on magazine covers. When a woman senses something is wrong in her own body before a test can prove it, she's called dramatic.
It's the exact same skill. You've been running the experiment on your own body for years. You know what makes your headache worse. You know which building makes you feel sick. You know your baseline better than anyone with a medical degree who's known you for fifteen minutes a year. That's not drama. That's data.
How to Talk to Your Doctor So They Actually Hear You
This part is genuinely actionable, so let's get practical. Dr. E explained that the language we use with our girlfriends doesn't always land the same way in an exam room. Saying "this is the worst headache of my life" or "my head always hurts" can actually work against you, because clinicians are trained to hear specifics, not intensity.
Before your next appointment, get specific:
What makes it better?
What makes it worse?
When does it happen, and how often?
Is there a pattern, time of day, activity, food, stress?
The more precisely you can describe your experience, the more credible it sounds, because you're speaking the language of an experiment your doctor already knows how to run.
The One Question to Ask Before You Leave the Exam Room
If your labs come back normal and you still don't feel like yourself, Dr. E suggests asking your provider directly: "What would it take for you to reopen this and look further?"
This question does two things. It tells you exactly where their threshold is, so you know if you're in the wrong office or just early in the process. And it keeps the conversation from ending at "you're fine." You're not asking them to promise something they can't. You're finding out what the next data point would need to look like.
Why You Need a Healthcare Team, Not Just One Doctor
We don't expect one vendor to plan an entire wedding. The DJ doesn't bake the cake. The florist doesn't do the photography. Yet somehow we expect one primary care provider to have every answer for every stage of our health.
Dr. E's advice: keep your doctors. Don't burn that relationship down. But start building a team around them, a hormone-focused provider, a nutrition-minded practitioner, a health coach, whoever fills the gap your primary doctor's toolbox doesn't cover. Being the CEO of your own health doesn't mean going it alone. It means knowing who's on your team and why.
FAQ:
What does it mean when a doctor says your labs are normal but you still feel sick?
It usually means your provider has exhausted the tools available to them, not that nothing is happening in your body. Standard labs often only flag a problem once it's fairly advanced, so "normal" reflects the limits of the test, not necessarily your full picture of health.
How do I know if I'm actually being medically gaslit, or if my doctor really has done everything they can?
Ask yourself if your provider truly listened, ran relevant tests, and explored your concern, or if they dismissed you outright. If they did the work and still came up empty, that's a toolbox limitation, not gaslighting. If they didn't listen at all, it's worth finding a new provider.
What is "pre-disease" and why isn't it treated?
Pre-disease is the stage where something is shifting in your body but hasn't progressed far enough to meet an official diagnosis. Most conventional care doesn't have a category, a test, or a treatment plan for this stage, which is why so many people feel unheard even when nothing "shows up."
How do I advocate for myself at a doctor's appointment?
Be specific rather than dramatic. Describe exactly what makes symptoms better or worse, how often they happen, and any patterns you've noticed. Ask your provider what it would take for them to look further if your results come back normal.
What's the difference between "normal" and "optimal" health?
Normal is a population average, and population averages aren't always healthy. Optimal is about how you actually function and feel, not just where you land compared to everyone else.
Listen to the full episode with Dr. Efrat LaMandre on Apple Podcast | Spotify | YouTube.
