How to prevent medical gaslighting from harming patient safety

Ignoring patient concerns comes with risks

Ignoring or not listening to and absorbing patient concerns come with grave patient safety risks.

"Health outcomes can only be successful if the patient is truly a partner in care," Davila explained. "When patients don't feel like their concerns are being heard or acted upon, they're not able to follow through with their part of ensuring that their health outcomes are there."

Patients who feel ignored or dismissed might not be able to develop strong trust in their provider, or they could struggle with medication adherence. In the worst of cases, patients whose concerns are dismissed might experience a missed or delayed diagnosis, threatening health outcomes.

Davila acknowledged that most healthcare providers do not dismiss patient concerns out of malice. Seldom does a provider intend to harm the patient-provider relationship or healthcare interaction.

But providers are also humans, she said, and they are liable to the same faults as their peers, including cognitive bias and implicit bias.

"Providers are in an environment in which they're seeing this patient and they're trying to synthesize the information as best that they can to make the best diagnosis for this patient," Davila noted. "Cognitive bias comes in because sometimes when we're under those more stressed conditions, our brain switches to a different type of thinking where we rely on different pathways for how we appraise information."

This can lead to diagnostic error, Davila said. For example, a patient might come in with a set of symptoms that, due to cognitive bias, a healthcare provider asserts indicate a certain diagnosis. Without listening to the full scope of patient symptoms, the provider might miss a key detail that allows for an accurate diagnosis. Implicit bias can compound this issue as a provider might unconsciously let a patient's demographics color the diagnosis or prognosis.

This all has clear impacts on patient safety. Missed and delayed diagnosis opens the door for patients to deteriorate. And if a patient is started on an inappropriate treatment, that might also have downstream effects.

But cognitive and implicit bias can also have another, less tangible consequence: medical gaslighting.

Medical gaslighting occurs when a patient perceives an interaction in which their provider was dismissive or invalidating of the patient's experience or symptoms. For example, medical gaslighting might occur when a provider downplays a patient's pain levels.

This phenomenon can have negative impacts on patient outcomes as well as the patient experience, namely, in harming patient trust.

Preventing medical gaslighting

Problems with medical gaslighting or dismissing patient concerns are preventable, Davila said, so long as healthcare organizations have the right data and culture of patient safety.

Importantly, hospitals and health systems need to be equipped with the type of patient feedback loops that make it easier to understand how often this is happening. After a patient or family caregiver has filed a complaint, health systems should employ a risk manager or other type of ombudsman within the patient advocacy office to assess the issue.

From there, hospitals and health systems need to be sure they aren't just addressing the individual complaint but rather putting that in the context of other complaints and the overall hospital patient safety culture.

Does the hospital have enough providers to meet patient demand? Does the health system have a high provider burnout rate? What are the office's scheduling policies? What are the practicing conditions that could have led to this incident?

"We do want to point out that we don't see this as an individual provider problem," Davila emphasized. "This is not about being punitive to anybody. Just like safety culture or workforce violence, this is an issue that is systematic and needs to be looked at from the ground up and from the top down."

Using a total systems approach to patient safety, healthcare organizations should look at every angle to address the problem, Davila advised. Health systems can split their strategies into three areas: leadership and organizational, data and feedback and healthcare provider coaching.

From a leadership level, this means opening up conversations with staff about the issue of medical gaslighting and how it affects patients. Operations leaders should look at scheduling policies, how long providers get to spend with patients and the other barriers keeping them from having deep conversations with patients.

In terms of data, health systems must give patients and family members the tools they need to provide all of the details of their medical encounter. In addition to collecting information about how often medical gaslighting happens, organizations should measure the severity of the incident. By being able to quantify the impact of the problem, organizations can better tailor their solutions.

Finally, health systems need to foster a better learning environment for their clinicians, Davila suggested. Coaching needs to happen at all experience levels, she said, and focus on how providers can facilitate patient-provider communication, ask open-ended questions and avoid leading questions.

At the end of the day, it all comes down to trust, Davila said.

Patients want to get healthy, and they rely on their healthcare providers to listen to their symptoms and help resolve them. When patients perceive their clinician as being dismissive of their symptoms or downplaying the severity, patients feel invalidated and might not want to meet with their provider again.

The downstream consequences of that are pronounced in a world defined by limited health literacy and rampant medical misinformation, Davila said.

"It all comes down to having that trusting relationship between the provider and the patient," she concluded. "Step one in building that trust is listening to your patient and having those honest conversations. When you don't build that trust patients, they will take matters into their own hands."

Sara Heath has reported news related to patient engagement and health equity since 2015.