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by Pamela Johnson, RN, BSN, CPHRM; and Joan M. Porcaro, RN, BSN, MM, CPC, CPHRM, DFASHRM

Each year, the Emergency Care Research Institute (ECRI) (1) issues its Top 10 Patient Safety Concerns. ECRI’s 2025 report identifies the dismissal of patient, family, and caregiver concerns as the foremost threat to patient safety. In their review, this safety concern was referred to as “gaslighting,” but it is often referred to as “medical gaslighting,” which involves invalidating a patient’s clinical concerns without proper evaluation.

According to the American Journal of Medicine, medical gaslighting is “an act that invalidates a patient’s genuine clinical concern without proper medical evaluation” (2). Medical gaslighting is derived from the term “gaslighting,” which is when an individual is manipulated into questioning their own perception. The term “gaslighting” was officially recognized by Merriam-Webster as word of the year in 2022 (3).

The Scope of the Problem

Statistics underscore the severity of this issue. In August and again in September 2023, HealthCentral (4), a digital health media company and online resource conducted a polling of their readership.  Hundreds of readers responded, and the resulting numbers follow:

o   94% said their doctors ignored or dismissed their symptoms, with nearly all of those experiencing this multiple times

o   61% reported being blamed for their symptoms or made to feel “crazy.”

o   55% said symptoms worsened after dismissal

o   28% experienced a health emergency as a result

o   71% experienced anger or patronization when questioning doctors

o    25% reported being denied access to medical records, which is illegal

o   44% said gender influenced care.

o   60% said age played a role.

o   6% cited race; 5.3% cited sexual orientation

How Medical Gaslighting Manifests

Medical gaslighting can take several forms, including minimizing symptom severity, interrupting patients, misattributing symptoms to unrelated conditions, refusing follow-up appointments or diagnostic tests, and exhibiting condescending behavior (e.g., suggesting that the patient is exaggerating).

Consequences and Disparities

These behaviors can lead to misdiagnosis, delayed treatment, prolonged suffering, emotional distress, deterioration of trust, and, in some cases, medical emergencies. The HealthCentral survey cited that 55% of respondents reported worsened symptoms after a doctor dismissed their concerns, and 28% said they experienced a health emergency due to a provider’s lack of response (4).

Certain populations are disproportionately affected by medical gaslighting (5). Studies indicate that Black patients and women are more likely to have their symptoms dismissed, particularly in pain management scenarios. This disparity contributes to existing health care inequities and emphasizes the need for culturally competent care.

Root Causes

Medical gaslighting is not driven by an intentional desire to manipulate patients, and clinicians may not be aware they exhibit the behavior. The root causes of medical gaslighting are multifaceted. Clinicians often operate under considerable time and resource constraints, making it challenging to provide empathetic, patient-centered care.

Cognitive Error: An estimated 28% of diagnostic errors are the result of cognitive biases (6). Examples of cognitive errors (7) in clinical care that could lead to dismissing a patient concern include:

•          Premature closure: stopping the decision-making process or investigation and accepting a conclusion before all relevant information is considered.
•          Diagnostic overshadowing: attributing symptoms to an existing diagnosis or comorbidity, e.g., obesity or substance abuse.
•          Confirmation bias: the tendency to interpret added information in a way that aligns with previous diagnoses.

Risk management and patient safety implications

Medical gaslighting, as noted earlier, has emerged as a top patient safety concern, with serious implications for both risk management and quality of care in health care systems. Here’s a breakdown of the potential key risks and safety issues:

Patient Safety Implications

1. Delayed or Missed Diagnoses
• Dismissing or minimizing symptoms can lead to critical delays in diagnosis, especially for conditions like cancer, autoimmune diseases, or heart disease (8).
• ECRI reports that 28% of patients who experienced gaslighting later faced a health emergency due to their concerns being ignored (9).
2. Worsening of Symptoms
• When patients are not believed, they may delay seeking further care, leading to disease progression and more complex treatment needs.
3. Increased Health Disparities
• Marginalized groups—especially women, Black patients, and LGBTQ+ individuals—are disproportionately affected, exacerbating inequities in care (2).
4. Erosion of Trust
• Patients who feel dismissed are less likely to follow medical advice, return for follow-up, or engage in shared decision-making, undermining long-term health outcomes (10).

Risk Management Implications

1. Legal Liability
• Failure to take patient concerns seriously can result in malpractice claims, especially if harm results from a missed or delayed diagnosis.
2. Reputational Damage
• Reports of gaslighting can damage a health system’s public image, especially in the age of social media and online reviews.
3. Regulatory Scrutiny
• Accrediting bodies may view patterns of dismissive care as a violation of patient rights, leading to compliance issues.
4. Workforce Burnout and Bias
• Clinician time pressures and cognitive overload contribute to gaslighting behaviors. Addressing this requires system-level changes in scheduling, staffing, and training.

Organizational readiness and risk management mitigation

Addressing medical gaslighting—when a patient’s concerns are dismissed, minimized, or invalidated by health care providers—requires a system-wide cultural and operational shift. Here are key strategies a health system can implement:

1. Educate Clinicians on Implicit Bias and Communication

• Implicit bias training helps providers recognize unconscious attitudes that may lead to dismissive behavior, especially toward women, BIPOC, LGBTQIA+ individuals, and patients with chronic or poorly understood conditions (8).
• Communication skills workshops can teach clinicians to listen actively, validate patient experiences, and avoid minimizing language.

2. Promote Patient-Centered Care (11)

• Empower patients to recognize medical gaslighting.
• Encourage shared decision-making, where patients are active participants in their care.
• Use trauma-informed care principles to create a safe, respectful environment.
• Implement standardized symptom checklists to reduce subjective dismissal of symptoms.

3. Strengthen Patient Advocacy and Feedback Channels (11)

• Establish patient advocate roles or ombuds services to support individuals who feel unheard.
• Create anonymous reporting systems for patients to share concerns about provider interactions.
• Regularly review patient satisfaction and complaint data for patterns of dismissive care.
• Expand access to patient advocates or ombuds services.
• Provide clear signage and materials informing patients of their right to be heard and how to escalate concerns.

4. Diversify Clinical Guidelines and Research

• Update diagnostic protocols to reflect gender- and race-inclusive data, especially for conditions like heart disease, autoimmune disorders, and reproductive health (11).
• Encourage research that includes diverse populations to reduce diagnostic disparities.

5. Leverage Technology Thoughtfully

• Use AI and clinical decision support tools to reduce diagnostic bias and ensure consistency in care (8).
• Implement electronic medical record prompts that remind clinicians to offer follow-up or second opinions when symptoms are unclear.

6. Foster a Culture of Accountability and Empathy

• Include gaslighting awareness in onboarding and continuing education.
• Encourage peer review and reflection on missed diagnoses or patient complaints.
• Recognize and reward empathetic care behaviors in performance evaluations.

7. Policy Development

• Create a formal policy defining medical gaslighting and outlining expectations for respectful, evidence-based patient communication.
• Include zero-tolerance language for dismissive or biased behavior.

8. Clinical Decision Support

• Use electronic medical records prompts to encourage documentation of patient-reported symptoms and follow-up plans.
• Implement checklists for high-risk symptoms (e.g., chest pain, fatigue, neurological issues) to reduce diagnostic bias.

For the Provider

Gaslighting (12) in health care often occurs unintentionally and can lead to delayed diagnoses, mismanagement, and erosion of trust. It disproportionately affects marginalized groups and patients with chronic or complex conditions.

Self-reflection is critical for preventing medical gaslighting. Here are practical strategies doctors can use to build awareness and avoid dismissive behaviors with their patients:

• Complete implicit bias training or training on trauma informed care
• Seek feedback from the patient, ask, “Did you feel heard today?”
• Remain focused on common biases such as gender, age, race, and weight)
• Practice self-reflection and after each patient encounter, ask:

• •          Did I listen fully without interrupting?
  •         Did I validate the patient’s concerns?
  •         Did I rely on assumptions or stereotypes?

Conclusion

Addressing this patient safety concern requires a comprehensive, systems-based approach. Health care organizations should examine scheduling policies to ensure clinicians have adequate time with patients, implement empathetic listening techniques, and provide education on conditions that are misunderstood, such as fibromyalgia. Patients should be directly asked if their concerns have been addressed to engage them as equal partners in their care and empower them to understand their diagnoses and ask questions.

Fostering open conversations about medical gaslighting, prioritizing workforce diversity, and utilizing simulation training can also help clinicians recognize and mitigate their biases. This patient safety concern presents an opportunity for leaders and health care professionals alike to consider how they can take a total systems safety approach to redesigning elements of the patient-provider interaction.

References

1. Medical gaslighting' tops patient safety concerns for 2025: ECRI Retrieved from:  https://home.ecri.org/blogs/ecri-thought-leadership-resources/top-10-patient-safety-concerns-2025. 

2. Ng, I. K. S., Tham, S. Z. L., Singh, G. D., Thong, C., & Teo, D. B. (2024). Medical gaslighting: A new colloquialism. The American Journal of Medicine, 137(10), 920–922. https://doi.org/10.1016/S0002-9343(24)00396-6

3. Merriam-Webster. Word of the Year 2022. Source : Retrieved from:   https://www.merriam-webster.com/wordplay/word-of-the-year-2022.

4. Kennedy, L. P. (2023, September 28). What you told us about medical gaslighting. HealthCentral. Retrieved from: https://www.healthcentral.com/chronic-health/what-you-told-us-about-medical-gaslighting

5. Ng, I. K. S., Tham, S. Z. L., Singh, G. D., Thong, C., & Teo, D. B. (2024). Medical gaslighting: A new colloquialism. The American Journal of Medicine, 137(10), 920–922. https://doi.org/10.1016/S0002-9343(24)00396-6

6. Graber, M. L., Franklin, N., & Gordon, R. (2005). Diagnostic error in internal medicine. Archives of Internal Medicine, 165(13), 1493–1499. Retrieved from https://doi.org/10.1001/archinte.165.13.1493

7. Ly, D. P., Shekelle, P. G., & Song, Z. (2024). Evidence for anchoring bias during physician decision-making. JAMA Internal Medicine. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2806464

8. Shane K, Sood N, Slonim A. Exploring Medical Gaslighting: Efforts to Enhance Communication and Trust in Healthcare. Physician Leadership Journal. (2025);12(2)13/19. https://doi.org/10.55834/plj.1846937739

9. Muoio, D. (2025, March 10). 'Medical gaslighting' tops patient safety concerns for 2025: ECRI warns. Fierce Healthcare. https://www.fiercehealthcare.com/providers/medical-gaslighting-top-patient-safety-concern-2025-ecri-warns

10. Godman, H. (2024, April 1). What to do about medical gaslighting. Harvard Health. https://www.health.harvard.edu/staying-healthy/what-to-do-about-medical-gaslighting

11. Viscomi, L. (2023, April 24). Empowering patients: Strategies for recognizing and overcoming medical gaslighting. Healthgrades Partner Solutions. https://b2b.healthgrades.com/insights/blog/strategies-for-recognizing-and-overcoming-medical-gaslighting/

12. Exploring Medical Gaslighting: Efforts to Enhance Communication and Trust in Healthcare. https://www.physicianleaders.org/articles/doi/10.55834/plj.1846937739

Authors

Pamela Johnson, RN, BSN, CPHRM is the Director of Patient Safety and Risk Management for Copic.

Joan M. Porcaro, RN, BSN, MM, CPC, CPHRM, DFASHRM is the Senior Vice President of Risk Services at WTW.