Medical Gaslighting: Listening as a Patient Safety Strategy

Most physicians do not enter an exam room intending to dismiss a patient’s concern. In fact, the opposite is usually true: clinicians are trying to solve complex problems under time pressure, with incomplete information, administrative demands, and the cognitive shortcuts required to move through a busy clinical day. But even when unintentional, dismissing or minimizing a patient’s symptoms can have serious consequences like missed diagnoses, delayed treatment, avoidable harm, and erosion of trust.

That is why “medical gaslighting” has become an important patient safety concept. In a recent episode of Copic’s Within Normal Limits podcast, Dr. Eric Zacharias and Dr. Susan Sgambati describe medical gaslighting as the invalidation of a patient’s genuine concerns without appropriate evaluation or investigation, not as deliberate manipulation, but more often as an unconscious cognitive and systemic phenomenon.

The American Journal of Medicine¹ similarly defines medical gaslighting as the inappropriate dismissal or invalidation of clinical concerns, while noting that the term can be overused when applied to any disagreement or difficult clinical interaction.

Why This Matters Now

In 2025, ECRI² named “risks of dismissing patient, family, and caregiver concerns” as a top patient safety concern of the year. ECRI noted that time constraints, resource limitations, communication challenges, and clinician bias can contribute to missed or delayed diagnoses when patient concerns are not fully heard. ECRI also emphasized that these events are often products of the systems in which clinicians and patients operate, not simply isolated failures by individual physicians.

The connection to diagnostic error is especially important. The National Academies’ landmark report Improving Diagnosis in Health Care³ defines diagnostic error as the failure to establish an accurate and timely explanation of the patient’s health problem or to communicate that explanation to the patient.

Recent research underscores the scale of the problem. A 2024 diagnostic safety primer from AHRQ PSNet⁴ notes that diagnostic errors remain a major patient safety issue and that cognitive shortcuts—while often necessary and useful—can contribute to errors such as anchoring, premature closure, availability bias, and overreliance on test results.

"Medical gaslighting can damage trust and make patients less likely to seek care in the future. Recommending preparation, symptom tracking, questions, and support persons are ways for patients to participate more effectively.”

When “Efficient Thinking” Becomes a Risk

Physicians rely on mental shortcuts to practice efficiently. Pattern recognition is often a clinical strength: chest pain plus diaphoresis raises concern for acute coronary syndrome; fever during respiratory virus season may reasonably suggest a viral illness. But, these shortcuts can become vulnerable to error when they harden into assumptions.

Common cognitive traps include:

• Premature closure: stopping the diagnostic process once a “good enough” answer appears.
• Availability bias: overestimating a diagnosis because it has been seen repeatedly or recently.
• Anchoring: holding onto an initial impression despite new or discordant information.
• Framing effects: allowing contextual cues such as prior labels, behavioral history, weight, age, or mental health diagnoses to shape interpretation of symptoms.

These same biases are well-recognized in diagnostic error literature. AHRQ PSNet describes how heuristics can lead clinicians to miss atypical presentations or coexisting conditions, especially when time pressure and incomplete information are present. In the podcast, Dr. Zacharias offers a practical example: chest symptoms may trigger an ACS workup, but a normal troponin should not prematurely close the door on other high-risk diagnoses such as dissection, pulmonary embolism, or pericarditis.

Language That Closes Doors—and Language That Opens Them

Medical gaslighting often shows up in communication before it shows up in the chart. The podcast highlights “never words”—phrases that may feel efficient to the clinician but can shut down dialogue for the patient. Examples include: “You need to be realistic,” “It’s just part of the disease process,” “I already explained this,” “Let’s not worry about that now,” or “I’ve been doing this for 20 years.”

These phrases can unintentionally communicate that the patient’s experience is not credible or worth further exploration. A more productive approach is to validate the concern without overpromising certainty:

• “Your symptoms are real, and I want to understand what we may be missing.”
• “The tests we have so far have not shown a cause, but that does not mean nothing is going on.”
• “Let’s step back and revisit the timeline.”
• “Here is what would make me want you to call, return, or go to the emergency department.”

This kind of language supports diagnostic humility. It also protects the therapeutic relationship. Harvard Health5 notes that medical gaslighting can damage trust and make patients less likely to seek care in the future, while recommending preparation, symptom tracking, questions, and support persons as ways for patients to participate more effectively. For physicians, the parallel obligation is to create clinical space where that participation is welcomed.

"When symptoms are persistent, atypical, or multisystemic, consider referral, curbside consultation, or team-based review.”

Practical Takeaways for Clinicians

1. Pause when the story does not fit. A return visit, persistent symptoms, new neurologic findings, escalating pain, or a patient saying “this feels different” should trigger a diagnostic pause. The goal is not to order every test—it is to deliberately reconsider the working diagnosis.
2. Use “diagnostic time-outs.” Ask: What else could this be? What diagnosis would be dangerous to miss? What data does not fit? What am I assuming about this patient? These questions help shift from fast, intuitive reasoning to slower, more analytical thinking when uncertainty is high.
3. Document the patient’s words. Dr. Sgambati recommends capturing the patient’s exact words before translating them into clinician interpretation. This can reduce bias in the record and preserve clues that may matter later.
4. Avoid labels that undermine credibility. Terms such as “complainer,” “dramatic,” or “difficult” can follow patients through the chart and shape future care. If behavior is clinically relevant, document objective observations and the clinical response.
5. Normalize uncertainty. Saying “I don’t know yet” is not a failure. It can be a sign of careful medicine—especially when paired with a plan, follow-up, safety net instructions, and shared decision making.
6. Bring in help early. When symptoms are persistent, atypical, or multisystemic, consider referral, curbside consultation, or team-based review. As the podcast notes, calling a colleague and saying, “I’m struggling with this case. Can I walk you through it?” can be both clinically useful and professionally grounding.

Summary

Medical gaslighting is not just a communication issue; it is a patient safety issue. It sits at the intersection of diagnostic reasoning, trust, bias, documentation, and system design. The solution is not to abandon clinical judgment or treat every patient concern as equally probable. Rather, it is to remain curious when the clinical picture is incomplete, to recognize when cognitive shortcuts may be narrowing the differential, and to communicate in ways that preserve the patient’s role as a partner in diagnosis.

¹ https://www.amjmed.com/article/S0002-9343%2824%2900396-6/fulltext
² https://home.ecri.org/blogs/ecri-thought-leadership-resources/top-10-patient-safety-concerns-2025
³ https://nap.nationalacademies.org/resource/21794/interactive/
⁴ https://psnet.ahrq.gov/primer/diagnostic-errors
⁵ https://www.health.harvard.edu/healthy-aging-and-longevity/what-to-do-about-medical-gaslighting

Article originally published in Copic’s Copiscope 3Q26 newsletter.