What is medical gaslighting, and why should docs care?

Defining medical gaslighting

In short, medical gaslighting can refer to a healthcare experience that was invalidating for a patient, according to a Harvard Health Publishing article on the matter.

"Medical gaslighting describes when healthcare professionals seem to invalidate or ignore your concerns," Heidi Godman, executive editor of the Harvard Letter, wrote in the piece.

Medical gaslighting can happen when a healthcare provider ignores symptoms or complaints, denies care, denies symptoms or downplays symptoms.

At the crux of it all is invalidation, said a group of researchers writing in a 2024 American Journal of Medicine article.

"We define 'medical gaslighting' as an act that invalidates a patient's genuine clinical concern without proper medical evaluation because of physician ignorance, implicit bias or medical paternalism," the report authors wrote.

Indeed, that part about "proper medical evaluation" is important, they continued. That is because the medical examination can present a friction point for patients and providers.

When a clinician dismisses patient concerns without a thorough medical evaluation, that constitutes textbook medical gaslighting, the American Journal of Medicine authors suggested.

But when a clinician does perform a thorough exam, gray area emerges. Specifically, patients with known histories of psychiatric/somatoform disorder can present challenges to physicians seeking to validate genuine patient concerns while also avoiding unnecessary testing and evaluation.

There are also cases where a physician might decline patient needs for clinical reasons, the researchers added. For example, there might be some medical or physiological futility to a treatment the patient requested, like a patient requesting antibiotics for the common cold. Declining that treatment course is not medical gaslighting; it's antibiotic stewardship.

Still, healthcare providers need to practice good patient-provider communication skills to demonstrate why they do not align with the patient's presented symptoms or needs. Using clear and direct language to discuss why common cold symptoms do not require an antibiotic can support a better discourse and reduce the risk of the patient feeling dismissed or invalidated.

After all, medical gaslighting does come with consequences. In addition to making for a bad patient experience, medical gaslighting can pose patient safety risks as well as the following problems:

• Loss of trust in the healthcare provider or overall healthcare institution.
• Poor patient experience.
• Frustration and emotional distress.
• Worsening of health conditions.
• Missed diagnosis.
• Delayed diagnosis.
• Incorrect treatment.

Medical professionals seeking to prevent medical gaslighting should consider its causes and enhance their communication strategies accordingly.

Causes of medical gaslighting

Medical gaslighting is likely unintentional and not malicious. After all, very few healthcare providers set out to do harm.

Per the American Journal of Medicine authors, gaslighting in medical settings can be due to the following:

• Lack of knowledge or awareness of certain diseases.
• Preconceived notions of how certain diseases present.
• Unconscious or implicit bias toward certain patient populations.
• Medical paternalism.

Cognitive bias and limited disease knowledge

Cognitive bias refers to how the brain parses through information to come to an informed conclusion. It refers to the human brain's tendency to simplify information processing through a filter of personal experiences and preferences. Although experts say that filtering mechanism can be effective, it can also limit or cause errors in thought.

In a medical setting, cognitive bias can lead to instances of medical gaslighting. Healthcare providers might interpret patient symptoms through a filter of cognitive bias, leading them to dismiss or downplay patient symptoms.

Similarly, healthcare providers might filter patient reports through a lack of disease knowledge. A clinician with limited experience with certain diseases might not be able to draw accurate conclusions about a set of symptoms. This issue is exacerbated for conditions like long COVID, systemic lupus erythematosus and chronic Lyme disease, all of which have a limited clinical evidence base.

Because these disease states are complex and not well understood "many patients ending up on a diagnostic odyssey and having their complaints repeatedly dismissed or misdiagnosed in clinical settings," the American Journal of Medicine authors explained.

"In reality, 'functional' neurological symptoms or even florid psychiatric manifestations can often be caused by an underlying organic etiology but get misdiagnosed as primary mental health conditions due to physician ignorance and inadequate investigative efforts."

Notably, the problem of cognitive bias persists and perhaps even increases as the use of clinical algorithms increases. AI is not immune to cognitive bias, nor racial or sex biases, which can contribute to medical gaslighting.

Implicit bias

No human is free from bias, healthcare providers included. In fact, implicit bias is one of the most commonly cited contributors to medical gaslighting.

When a healthcare provider holds preconceived notions about certain patient populations -- whether they are aware of these biases or not -- that can color the way they treat the patient. For example, a common medical narrative about Black women is that they do not feel pain to the extent that other women do. This implicit bias might lead a healthcare provider to dismiss pain symptoms or withhold pain medications.

Indeed, medical gaslighting affects certain patient populations more often than others, experts agree. Most articles indicate that medical gaslighting is most commonly reported among the following populations:

• Women.
• Older adults.
• Racial/ethnic minorities.
• LGBTQ+ individuals.
• Psychiatric patients.
• Patients with chronic illnesses or chronic pain.

In one KFF survey, nearly half of women reported feeling dismissed by their healthcare providers or as though their providers made assumptions about them.

In another 2022 survey from MITRE conducted by Harris Poll, BIPOC, LGBTQ+ individuals and chronically ill patients said they experienced bias from their healthcare providers. Over half of the 2,000 surveyed patients said they felt dismissed, ignored or not believed by their healthcare providers. Researchers indicated a link between implicit bias and poor patient-provider interactions.

Medical paternalism, imbalanced power dynamics

Medical paternalism refers to the power hierarchies that have historically characterized the doctor-patient relationship. Sometimes described as a "doctor knows best" mindset, medical paternalism indicates that the healthcare provider has power over the patient.

"In such cases, the arrogance of physician superiority may lead to clinical symptoms being ignored and patient concerns remaining unaddressed," according to the American Journal of Medicine authors.

Medical paternalism compounds with cognitive bias and an industry-wide push for efficiency. When a healthcare provider has a paternalistic mindset, it may be more difficult to detect when cognitive bias is creeping into decision-making. That problem, coupled with a push for more efficiency, might also leave some clinicians not fully listening to or even outright ignoring patient symptoms that could shed light on a more accurate diagnosis.

Preventing medical gaslighting

Currently, much of the literature centers on how patients can report and prevent medical gaslighting. Indeed, medical gaslighting is a patient experience, so it makes sense that patient reports will be critical to flagging and addressing the problem.

However, healthcare providers should care about medical gaslighting and work to employ patient-provider communication skills that can help prevent it. This will help them relate to their patients better and could potentially lead to better clinical outcomes.

"Medical gaslighting raises serious ethical concerns. It violates the fundamental principle of 'do no harm' and can border on medical negligence," according to Hodgkins International, a patient advocacy group. "Awareness of these legal and ethical implications is essential for both healthcare providers and patients."

Avoiding medical gaslighting requires healthcare providers to demonstrate empathy and active listening, practice strong communication skills and engage in work that helps them identify their own biases.

Demonstrating empathy and active listening

Empathy and active listening skills are essential to helping patients feel seen and heard, which can counteract feelings of gaslighting even when a clinician disagrees with a patient need.

Providers might try repeating a patient's concerns or symptoms. This can help validate the patient's feelings and check the provider's understanding of the patient's needs.

Nonverbal cues such as nodding one's head and making eye contact help demonstrate active listening, which is key to letting patients know their symptoms and concerns have been fully absorbed by their providers. Clinicians should avoid interrupting patients while they speak, waiting for the patient to finish before adding their own thoughts or opinions.

Communication strategies to avoid medical gaslighting

In addition to listening to the patient, providers should employ strategies that help bridge gaps in understanding between them and their patients. This will be important when a provider's opinion or interpretation of symptoms differs from the patient's.

In these cases, healthcare providers should clearly explain the pathway or reasoning for why they came to a certain diagnosis or treatment plan. Those explanations should be clear and direct, plus account for differing patient health literacy levels.

Similarly, healthcare providers might consider shared decision-making in their practice. Clinicians can enhance shared decision-making by asking patients about their biggest concerns about their symptoms, diagnosis or treatment plan. This gives clinicians the knowledge and opportunity to validate and assuage patient fears.

Cognitive and implicit bias training

As some of the leading causes of medical gaslighting, programming to address cognitive and especially implicit bias is essential.

Implicit bias training has become more commonplace as healthcare organizations focus on health equity. These trainings, often hosted by individuals with human resources and community health backgrounds, are intended to help healthcare providers understand implicit bias, the impact it can have on care and how they can detect their own biases.

Providers who can detect their own biases will be better positioned to think critically during patient encounters.

Implicit bias training is usually recommended or required by healthcare organization leadership. However, providers practicing at organizations that do not offer such training might seek out training from other continuing medical education leaders.

As noted throughout, medical gaslighting can also indicate a health system issue. Some providers dismiss, ignore or do not listen to patient complaints because they are crunched for time or have to fulfill other regulatory requirements. Emphasizing models of care that allow for more patient-centricity will be key.

In doing so, healthcare organizations and the clinicians who work there can fully appreciate patient needs and symptoms. Ensuring providers have the time, tools and skills to fully listen to patient complaints will help reduce the risk of medical gaslighting.

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