As physicians, our primary goal is to provide the best possible care to our patients. However, even with the best intentions, medical gaslighting can occur, leading to patient distress and potentially harmful outcomes. Medical gaslighting is not often intentional. It can happen when physicians, under time constraints, facing diagnostic challenges, or experiencing burnout, inadvertently invalidate a patient’s symptoms or concerns.

Just a few years ago, I found myself on the other side of the exam room. The fatigue felt like gravity had been turned to the maximum level, I had dry eyes and a dry mouth. I told my primary care physician I was worried about Sjogren’s, and she replied, “I guess we can order the blood work, but I think you’re fine.” Thankfully, I had the privilege of knowing she was otherwise a nice and competent physician. But consider our patients who are not able to give the benefit of the doubt or have experienced medical trauma. It’s a bit easier to see how such instances could further erode patients’ trust. We know that negative interactions can lead to delayed diagnoses and appropriate treatment. This is especially true in chronic and invisible conditions where symptoms are often subjective and varied, like pain and fatigue.

Strategies for conscious care:

Active listening while channeling curiosity. Prioritize listening to learn from your patients. Encourage them to describe their symptoms in detail and avoid interrupting or jumping to conclusions. “Can you explain how fatigue is impacting your life?”

Emphasize empathy and validated lived experiences. A simple acknowledgment of their distress can go a long way in building trust. “I can see you are really hurting.” Also, taking a few cleansing deep breaths between visits helps me reset and recharge to be more present with each patient.

Thorough assessment as a team. Ensure a comprehensive assessment, especially in cases with non-specific symptoms, by taking a detailed history, performing a physical examination, and conducting appropriate investigations. I will often ask if there is a particular diagnosis or testing they had in mind so that we can take that into consideration as we come up with a plan together.

Building trust in patient relationships:

Transparent communication. Be honest about uncertainties in diagnoses or treatment plans. Involve patients in the decision-making process and inform them about the office ground rules for communication between visits too.

Continual education. Stay updated with the latest medical research, particularly about conditions with complex presentations.

Collaborative approach. Encourage a team approach not only with your patients but also involving other specialists if necessary. A multidisciplinary perspective can be invaluable in complex cases.

Addressing the challenges:

Time management. While time is often limited, try to allocate enough for each patient. Consider strategies like patient questionnaires to gather information efficiently and let patients know at the start of the visit the amount of time scheduled.

Reflective practice and prioritizing clinician wellness. Regularly reflect on patient interactions and what helps you show up fully in your work. Create boundaries to ensure you remain healthy and seek mentorship from colleagues who are thriving.

Patient education. Empower patients with educational resources. Informed patients are more likely to engage in meaningful discussions about their health.

By adopting these strategies, physicians can enhance patient care and reduce instances of medical gaslighting. Our goal is to provide compassionate, patient-centered care, ensuring all patients feel heard, respected, and involved in their health care journey.

How do you ensure your patients feel heard and understood in your practice?

Kara Wada is a quadruple board-certified pediatric and adult allergy and immunology, lifestyle, and functional medicine physician, a Sjögren’s disease specialist, and a Sjögren’s patient herself. She spent nine years on faculty at The Ohio State University Wexner Medical Center, where she served as associate program director of the allergy and immunology fellowship and led the Mast Cell Center of Excellence.

In 2025, she left academic medicine to build the kind of practice she could not find as a patient: the Immune Confident Institute, a national direct-care immunology practice licensed in 27 states. She treats the patients the health care system sends ping-ponging between specialists, people with complex, chronic, multisystem disease including mast cell activation syndrome (MCAS), dysautonomia, Sjögren’s disease, immune dysfunction, and the seronegative and “in-between” diagnoses that do not fit neatly into a single specialty.

Her premise is simple: These patients are not the problem. Fragmented care is. Medicine has become exceptionally good at looking through microscopes while losing sight of the telescope, the bigger picture of the person in front of us. Her work challenges a health care culture that demands compliance when it should assume competence, and aims to make strategic, compassionate immune-directed care the standard, and the exam room a place where patients are finally seen, heard, and believed.

Most of her reach is built outside the exam room. Her YouTube channel drew roughly two million views this past year, and more than 100,000 people follow her work across platforms, including a Sjögren’s community of about 6,600. She founded and hosts the Virtual Sjögren’s Summit, now in its sixth year and drawing some 4,300 registrants worldwide. She appears regularly on national television and in the health press, including Prevention, SELF, Good Housekeeping, WebMD, Medscape, and MedPage Today, and she writes for KevinMD on the diagnoses that live in the shadows and the medical gaslighting that surrounds them.

A TEDx speaker and sought-after keynote, Wada speaks to clinician and patient audiences about complex immune disease, the experience of being disbelieved, and what changes when the physician is also the patient. She is also an unlikely pageant titleholder, having served as Dr. Ohio America 2022 and Dr. Midwest America 2023, and has written about how pageantry sharpened skills medicine rewards but rarely teaches.

She earned her medical degree with honors from the University of Illinois College of Medicine at Peoria and completed internal medicine-pediatrics residency, allergy and immunology fellowship, and clinician educator fellowship at The Ohio State University and Nationwide Children’s Hospital. She lives in Columbus, Ohio, with her medical school sweetheart turned husband, Akira, and their three children.