A disparity of trust between clinicians and patients.
By Pete Mercer
In healthcare, one size does not fit all. Each patient has a unique and dynamic health background that often requires a tailored approach to addressing their health concerns. While there is an overall foundational approach to treatment options, it needs to be a good fit for the patient. Otherwise, they might be getting treatments that are not necessary, effective, or even worse, could cause further harm to the patient.
A recent report published by the ECRI found that “dismissing patient and caregiver concerns” is at the top of the list of the most significant threats to patient safety in 2025. In a media release regarding the report, ECRI says that “time and resource constraints make it increasingly difficult for some clinicians to provide empathetic care that addresses patient and caregiver concerns, potentially leading to missed and delayed diagnoses.”
This is indicative of a larger problem – a lack of trust between clinicians and patients. ECRI is referring to this phenomenon as medical gaslighting, a term that the American Journal of Medicine has defined as “an act that invalidates a patient’s genuine clinical concern without proper medical evaluation.”
To get a better understanding of what medical gaslighting is and how it impacts clinicians and patients alike, Repertoire Magazine spoke with Shannon Davila, MSN, RN, CPPS, CIC, CPHQ, FAPIC, executive director of total systems safety at ECRI, and Marcus Schabacker, MD, PhD, president and CEO of ECRI.
What is medical gaslighting?
An important thing to understand about medical gaslighting is that the traditional definition of gaslighting (i.e. manipulating someone in such a way that they begin to question their own sanity) does not apply to medical gaslighting. In a medical gaslighting case, patients feel that their health concerns are not being validated or addressed by their clinicians.
It is also important to understand that this is not a new experience. For years, patients have complained about feeling dismissed or not heard when it comes to their own health concerns. In recent years, there have been a couple of high-profile cases where celebrities have experienced medical gaslighting. After Serena Williams had a baby in 2017, she experienced shortness of breath and alerted medical staff to the issue. They did not believe her at first, but a CT scan revealed pulmonary embolism.
Sharon Stone has also recently been more candid about her experience with a ruptured vertebral artery in 2001. In her case, the doctors missed it on the first scan, so they assumed there was nothing wrong with her. After getting a second opinion, Stone had to undergo a procedure to get it fixed.
In both cases, the situation could have resulted in more serious injury or even possible death if they had not advocated for themselves over and over again. Celebrity cases like these go a long way in raising awareness for this issue. In the Hippocratic Oath, young and upcoming doctors swear to “do no harm” – the reality is that most healthcare professionals take that creed very seriously.
Davila said, “We wanted to be sensitive when we brought this issue up because healthcare is such a complex environment – doctors, nurses, and others are being asked to do so much with limited resources every day. Most people, the majority of healthcare workers, do not go to work saying, ‘I’m going to ignore or disregard a patient.’ No one has that intent. They always want to do the best for their patients.”
So, what is happening here? Without a doubt, healthcare workers face an enormous amount of pressure on a daily basis. They can only commit a certain amount of time to each patient, which creates this tension between caring for each patient and maintaining productivity goals. Additionally, cognitive bias can also lead to patients feeling as though they are being dismissed. The ECRI report found that, whether they know it or not, many clinicians have “biases that reflexively attribute symptoms to issues like mental illness, age, or weight,” which can greatly influence diagnostic decisions.
As an example for what this can look like, Davila said that if a clinician in an emergency department at a hospital sees five patients and they are all diagnosed with the flu, the sixth patient that comes in with a fever and a cough, it’s possible that that patient would be diagnosed with the flu as well.
Whether they know it or not, providers walk into each interaction with a patient with some sort of bias that is informed by circumstances that may or may not be related to the specific patient they are seeing. “You have to really think independently for each patient. Cognitive bias might be different than medical gaslighting, but it’s still not processing the information in a really critical and thoughtful way so that you can make the right diagnosis,” Davila said.
The patient-clinician relationship
Inevitably, this scenario will have an impact on the patient-clinician relationship. The most significant casualty in this medical gaslighting scenario is trust. Overcoming that barrier of distrust in the patient-clinician relationship is very difficult when the patient feels like they have been dismissed. With all of the health issues that many adults in America are facing right now, it’s really important to have a clear and open dialogue about what the patient is experiencing. If the patient does not feel comfortable sharing that information, it’s detrimental to the entire healthcare ecosystem.
Davila said, “A patient only has to feel like they have been dismissed once by someone. If you are having a conversation with anyone and you feel like they are being disrespectful or not hearing you, you are probably not going to feel comfortable communicating with that person.”
Once this starts to impact the patient-clinician relationship, it can become quite difficult to rebuild that trust. At some point, the patient could begin to withhold important information about their symptoms or their overall health. From there, any diagnosis that the clinician is going to give might be looked at with some measure of skepticism. If they do not feel that they can trust the clinicians, why would they trust the diagnosis?
That’s even assuming that the diagnosis is correct – if the clinician is given the full scope of health or they are not listening to the concerns of the patient, it becomes much easier and much more common to misdiagnose.
“From a clinical standpoint, it really opens up the opportunity for diagnostic errors,” Davila said. “If patients do not feel comfortable sharing about things like depression and anxiety – or in the case of Serena Williams, a physical chest pain – then you are going start seeing that the providers are not getting the information that they need to adequately make those diagnoses.”
Davila and her team found that by putting medical gaslighting as a top safety concern, they had multiple people share that they had also experienced medical gaslighting at some point. While they knew it was important to use this as an opportunity to educate providers about this issue, it was not the only goal of the report.
“We know nobody wants to be perceived as dismissing patient’s concerns. We saw an opportunity to educate health providers, but this was not just about education – we also wanted to acknowledge the patients and families. We know this is happening and we really wanted to help their voices be heard,” Davila said.
What can be done?
With a clearer picture of the scope of medical gaslighting, how can healthcare organizations put structures in place to fix this? ECRI president and CEO Marcus Schabacker said that the first step to rectifying any of the systemic flaws that perpetuate adverse events like medical gaslighting and cognitive bias is to create an environment where the staff feel safe to report errors, near misses, and system vulnerabilities. He calls this a ‘just culture.’
“Just culture is a model of accountability – one that applies not only to individuals, but also to the organization itself,” he said. “It recognizes that while individuals are responsible for their choices, the organization is responsible for shaping those choices. In a just culture, clinicians are held responsible for their actions. At the same time, the organization is accountable for designing systems that support safe, effective care and for responding to failures with learning, not punishment.”
When staff members feel safe to report any issues, it will help healthcare organizations to build robust data that gives a better picture of any vulnerabilities and risks. From there, the data can be analyzed to identify the challenges and create proactive prevention measures to mitigate those challenges.
According to Schabacker, leaders have to model transparency, reinforce safety as a core value, and ensure that policies and workflows reflect the realities of the clinical practice to reinforce the accountability between clinical staff and clinical leadership. If it’s going to work, leadership has to set the tone for the rest of the organization.
On the other side of the equation, frontline clinicians need to know that speaking up about risks or mistakes is not just safe, but an expectation. “Together, this dual accountability creates the foundation for total systems safety: a healthcare environment where safety is embedded, trust is reinforced, and learning is continuous.”
Improving patient safety through a unified, systems-based solution
Ensuring the safety of the patient is paramount to improving the quality of the clinician-patient relationship and eradicating medical gaslighting. Developing a systems approach is essential for healthcare organizations that are aiming to achieve safe, high performing, and efficient patient care, rooted in the understanding that healthcare is a complex, adaptive, sociotechnical system.
“Outcomes are shaped not just by individual actions, but by the design of the system itself: its physical environment, tasks and processes, tools and technologies, organization, and people, as well as the external environments,” Schabacker said. “A systems-based approach seeks to identify and redesign the system components that influence outcomes in a manner that facilitates safe, effective, and efficient care.”
Improving patient safety protocols requires an all-hands-on-deck, uniform approach to overcome these challenges. According to Schabacker, shifting towards an integrated, system-wide strategy is the most effective way to improve patient safety, like embedding safety deep into the organizational culture, aligning incentives, and using shared frameworks to guide improvement at each stage of the journey.
Building a strong safety culture is a big step towards improving patient safety, simply by making it a priority across the board. He said, “A strong safety culture is one where safety is not just a priority, but a core value embedded in every decision and process. Cultivating this culture requires more than training, slogans, or frameworks. It involves redesigning systems to support safe behaviors, aligning policies with values, and modeling safety leadership at every level.” Implementing a culture that’s focused on safety will also require a unified front to ensure that everyone is aligned with the mission and vision of the leadership team.
Without that unified approach, these strategies often result in greater fragmentation, which is another significant barrier to patient safety. If your organization is implementing siloed safety measures, it is much more difficult to scale these operations or align them with other departments in the organization.
Obviously, this does not create a sustainable, system-wide change for providers. By leveraging unification and standardization, healthcare leaders are able to establish a firm foundation of safety that reflects the goals and vision of the entire organization, making it easier to create meaningful change. However, the main caveat here is that leadership needs to be willing to accept the hard truth about the state of patient safety today.
As organizations like ECRI continue to shed light on these issues, it will continue to bring awareness to things like medical gaslighting. But it requires the leadership teams to make challenging decisions in order for anything to change. “As long as boards, CEOs and senior executives continue to accept the alarmingly high rates of preventable harm in healthcare today as collateral damage, things will not change. We also need patients and the general public to become more aware and more vocal about the need to make healthcare safer.”