First Do No Harm. The Ramifications of Medical Gaslighting

 Written by: Phyllis S. Quinlan, PhD, RN, NPD-BC

Gaslighting by clinicians occurs when healthcare professionals employee biased judgment instead of curiosity and dismiss, minimize, or doubt a patient's reported symptoms without proper evaluation. This practice has emerged as a credible threat to patient safety, trust, and the integrity of healthcare delivery. All patients can experience this dismissive approach however, gaslighting disproportionately occurs in the vulnerable populations, women, people of color, individuals with chronic pain or mental health conditions, and the elderly.

How It Shows Up
Medical gaslighting is subtle. Clinicians may interrupt patients, attribute physical complaints to unsubstantiated stress, resist ordering tests, or insist symptoms are psychologically based. Patients on the receiving end of these behaviors often question their own sense of health. Being summarily dismissed leads to self-doubt that then translates into avoidance of medical care often leaving conditions untreated thereby increasing the risk negative outcomes.

Impact on Vulnerable Populations
Women often face accusations of malingering and are left to navigate medical gaslighting. Many consider abandoning care due to repeated condescension by clinicians normalizing migraine, chronic fatigue, and menstrual pain. Women are less likely to receive full cardiac work-ups which contribute to heart disease being the number one cause of death in women. Racial bias dismissal of concerns during pregnancy and postpartum care can lead to a lack of proper assessment and undertreatment. These experiences discourage patients of color from seeking timely care and can place the life of the woman and her child at risk.

Patients living with mental health conditions face diagnostic overshadowing. Physical symptoms are attributed to their psychiatric diagnosis rather than organic etiologies. Patients reporting chest pain may have cardiac causes overlooked because clinicians presume the etiology is psychological. These clinical blind spots allow serious medical conditions to go undetected.

The elderly are vulnerable to age-related biases that lead clinicians to dismiss symptoms as inevitable consequences of aging. New cognitive changes may be attributed to age rather than evaluated for reversible causes like medication interactions or infections. Elderly patients often struggle with self-advocacy. When age converges with gender, race, or psychiatric history, compounding layers of bias makes gaslighting more likely.

Root Causes and Solutions
Medical gaslighting rarely has malice as a root cause. It is fueled by implicit biases, time pressures, insufficient training, hierarchical cultures that emphasis quick clinical judgment and downplay empathy. Clinicians must be allowed to practice relationship-centered communication, permitting patients to fully express concerns when diagnoses remain unclear. Programs are needed to raise awareness to implicit-bias and foster cultures that encourage inquiry over unsubstantiated certainty.

Reforms are needed to permit longer appointments for complex cases, allowing physician-driven diagnostic protocols instead of cost saving algorithms developed by third party payors. Patients should be empowered to bring or access advocates for appointments. Healthier workplaces must be the leadership imperative of today. Improved staffing, balanced workloads, and supportive cultures are essential to empathetic, thorough medical care. Acknowledgement of and confronting medical gaslighting by healthcare leadership is critical.

Remember the oath, first Do No Harm.