The Nice Dismissal - Part 1: How Medical Gaslighting Has Evolved

Sylvia Reisman, Principal & Founder, Private Health Advisor

I am a Private Health Advisor. My career is built on clinical collaboration—the kind that reduces a physician’s liability and ensures a patient is prepared for a successful outcome.

I "talk the talk" when navigating my high performing client's health concerns and the medical terminology that comes with them. I use strategies to ensure my clients' physical realities aren't ignored in the examination room. I serve my clients concierge level needs while collaborating with physicians, creating a win-win that ensures nothing is misunderstood and every question is freely asked.

I've spent years decoding complex health puzzles-for my clients and myself.

My experience was shaped by more than a decade of honing my detective skills, navigating my own complex case and discovering I had two medical misdiagnoses over the course of 30 years.

Back then, I knew when I was being brushed aside — in most cases not out of malice, but because most practitioners were pressed for time, offering quick band-aid solutions rather than identify the root cause of my illness.

I know firsthand what it feels like when a practitioner ignores, deflects or minimizes valid symptoms, which severely impact your quality of life.

During my long journey, I learned to carefully review medical records, lab results, and consult notes with a detective’s eye — not just what they show on paper, but what questions they raise and patterns they hint at.

Armed with years of personal experience and hard-earned insight, I could quickly recognize the red flags and patterns that many practitioners miss because they are trained and focused on a single medical specialty, which limits their ability to see the whole health picture.

Today I use this insight to guide deeper conversations, asking probing questions and carefully assessing the full picture.

NOW —20 YEARS LATER —I'm caught in a medical drama created by male surgeons who decide to cherry pick patients.

Three male surgeons playing down my large hiatal hernia that I had pursued getting tested for in 2023 — due to symptoms that were disrupting my quality of life as a cyclist and ability to engage in weight training for my muscle and bone health.

The more things change, the more they stay the same. Two decades after my own ordeal started, I'm seeing the same patterns — now wrapped in polite professionalism, diagrams, and calm voices.

Medical Gaslighting has evolved. In 2023, it was a top trending topic and even made the pages of The New York Times. Practitioners have learned that obvious gaslighting gets called out—so now it’s packaged in politeness, diagrams, and calm voices.

It looks professional. And it leaves the patient just as abandoned — only now they’re expected to be grateful.

I thought I had seen and experienced it all from 2005-2011. After falling mysteriously ill and seeing aproximately 25 physicians in Florida and Georgia, I was forced to travel to New York City to obtain a proper diagnosis for two of my puzzle pieces.

I spent years of horrific suffering while many of the doctors in the south did little or nothing to find answers.

This isn’t just my story; it’s a warning of how deep the systemic failure really goes when top surgeons gamble with a patient's health — choosing inaction over intervention, or downplaying symptoms, while holding the power to make life-altering decisions.

Let’s talk about what I call the Nice Dismissal.

It’s when a doctor:

• Appears attentive

• Speaks kindly

• Never raises their voice

• Never outright says “I don’t believe you”

But also:

• Doesn’t examine you

• Doesn’t engage with your narrative

• Doesn’t integrate symptoms with documented findings

• And quietly steers away from the obvious problem

You leave thinking: Was I heard? Or was I politely redirected?

Example: “The Guru”

I didn’t make that name up- that nickname came out of the mouth of my second opinion surgeon.

I still can't believe he actually said it to my face. He delivered it casually, as if it were reassuring, but I could clearly see he had formed a biased opinion instead of an independent second opinion.

“You’ve already seen the guru hernia surgeon. I can't believe he didn't want to operate on you.”

Let’s pause there.

Doctors don’t seem to realize what happens when they talk like that in front of patients.

What I heard was:

• This hierarchy is closed.

• Someone above me already formed an opinion.

• You are not starting fresh here.

That’s the first step in a Nice Dismissal — an appeal to authority instead of clinical curiosity.

How the Nice Dismissal Works

Question the Test, Not the Symptoms

I brought my endoscopy report with color images to my second and third opinion surgeons. The report description included a 5‑centimeter hiatal hernia. I'm 5'5" inches tall and weigh 116 pounds. In a 116-pound frame, there is no "extra room."

A 5-centimeter structural gap isn't just a clinical finding on a page; it is a physical blockade that leaves my internal organs with nowhere to go."

The Cleveland Clinic warns that very large hiatal hernias warrant repair to prevent dangerous mechanical complications like "volvulus"—where the stomach twists on itself. Other clinical benchmarks categorize hernias 5 cm or larger as "large," yet I was being told by a top surgeon that mine wasn't significant enough to warrant his attention.

This wasn't a difference of medical opinion; it was a denial of established clinical facts.

Instead of asking me (the patient):

How does this positive finding from 2023 correlate with her symptoms now, surgeon #3 chose not to ask me any questions related to my current symptoms, including my vomiting episode that I shared with him both in writing and verbally.

Creative Deflection

The focus of surgeon #3 became:

“Well, your hernia could be smaller than 5 - centimeters. The air used during the procedure could make it look larger than the endoscopy report decription.”

Me thinking:"really?"

As a Private Health Advisor, I know that "air insufflation" is a standard part of every endoscopy, not a variable that magically adds centimeters to a structural defect. This wasn't a clinical nuance; it was a creative excuse to avoid a complex repair on an active patient.

The last time I heard a deflection this creative was when Lyme patients in the South were told they couldn’t possibly have Lyme—because "apparently" deer and ticks just politely stop at the state line. Spoiler: they don’t.

Minimize What Doesn’t Fit the Script

I described something very specific to surgeons #2 and #3.

I experienced intense burning localized to the hernia area that occurred several hours after a 21 mile bike ride. The burning was so severe that I violently vomited undigested food TWICE in the middle of the night.

This is not normal physiology and could have been a serious, life-threatening situation. Given my strong family history of structural hernias and emergency strangulations, my concerns weren't based on anxiety—they were based on a documented genetic risk that these surgeons chose to ignore."

Surgeon #3's responses included:

“Belching when lifting weights doesn’t really mean anything.”

“But you don’t have heartburn.”

Me: "Does every patient with a hiatal hernia have heartburn?"

Surgeon #3: "not necessarily"

Me: Air silence for "let that sink in"

When a symptom doesn’t fit the insurance company's diagnosis guidelines, it’s quietly dismissed.

Replace Engagement With Tests

Insurance companies will gladly pay for tests and medications instead of addressing a known structural/mechanical issue.

Rather than the surgeon(s) examining me physically, I was offered by the third surgeon:

• A gastric emptying study

• A repeat barium swallow

Tests that do NOT:

• Diagnose a hiatal hernia

• Explain exertion‑induced vomiting

• Allow the surgeon(s) to conveniently postpone any decision about the mechanical issue already documented.

This is the hallmark of a Nice Dismissal.

Ordering tests that won’t address the clear mechanical problem identified over two years ago, ignoring the patient’s long-term clinical symptoms and life-threatening exercise-induced vomiting.

Never Say “No” — Just Never Say “Yes”

At no point did the surgeon say: “I don’t think surgery is indicated.”

Instead, the unspoken message was implied.

Let’s just keep checking other things. Let’s rule this out. Let’s rule that out.

Indefinitely.

That’s not caution. That’s avoidance.

If I am a concierge health advocate — with years of experience in complex healthcare navigation and the resourcefulness to identify the SAGES Clinical Guidelines (the national "Rulebook" outlining best-practice standards that surgeons are expected to follow) what does it mean when I'm still being sidelined by three hernia surgeons? What does that mean for the average person?

My experience isn't unique. Far too many smart, capable women with symptomatic hiatal hernias which are impacting their quality of life are met with nice dismissal by male surgeons.

In part two of this series, I dive into my diverse but alarming encounters with three hernia surgeons and the challenges women with symptomatic hiatal hernias often face when seeking surgical care. While this is my story, it also reflects a broader pattern affecting thousands of women. I also reveal the paper trail where "polite professionalism" turns into documented fiction.

If you’re ready to take your health seriously and ensure you're not dismissed,

contact me today. Let's create a proactive strategy to protect and optimize your quality of life and legacy.

To Your Health,  

Sylvia Reisman  

Founder & Principal Consultant  

Note: I now refer to my practice as a private health advisor service.

This newsletter contains my personal opinions and observations, based on my experience, and should not be interpreted as verified fact or professional guidance.

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