You are the expert of your body. You know when something isn’t right.

Yet many patients leave an exam room feeling worse than when they came in, not because of their illness, but because they were told, directly or indirectly, that nothing is wrong. Their symptoms are minimized, reframed, dismissed, or worse, attributed to anxiety, stress, age, or weight. They are left questioning their own experience and perception of reality.

This is what we know as medical gaslighting, and it has become a troubling problem for both patients and health care professionals. It’s the number one safety concern of 2025 according to ECRI (Emergency Care Research Institute).

The scope of the problem

Medical gaslighting isn’t rare. A 2023 BMJ Quality & Safety report estimated that diagnostic errors lead to nearly 800,000 Americans each year who die or suffer permanent disability. Women, people of color, older adults, and individuals in larger bodies are more likely to have their symptoms dismissed or attributed to psychological causes. Vague symptoms in addition to pain, like chronic fatigue, are often minimized by treating doctors. A 2015 Journal of Pain study found that 77 percent of both men and women felt their clinicians discounted or dismissed their pain, and women were twice as likely to report this.

These numbers reflect a growing reality: patients are feeling unheard, unseen, and sometimes even blamed in the very places they turn for help.

But to truly solve this problem, we still need to understand both sides of the stethoscope.

The patient’s view: “I wasn’t believed”

Gaslighting from a patient’s perspective often begins subtly: a raised eyebrow, a quick interruption, or a shrug that signals, “It’s nothing. Are you sure it’s that severe?”

Patients describe coming in with real symptoms (pain, weakness, fatigue, shortness of breath) only to leave with no explanation and the sense that their concerns were not taken seriously. For some, delayed diagnosis carries life-changing consequences: worsening disease, unnecessary suffering, or, in extreme cases, loss of life.

And yet, this is only half the story.

The doctor’s view: “I want to help, but I’m drowning”

Most physicians do not intend to gaslight. The term implies manipulation, yet in medicine, the issue is usually far more complex.

Today’s health care environment places clinicians under unprecedented pressure. The average primary care visit lasts 15 minutes or less, during which the physician must:

• Review a chart
• Listen to the patient
• Document extensively
• Communicate risks and next steps
• Navigate insurance and administrative requirements

A time-motion study shows physicians spend nearly a third of their office day on electronic records and desk work, almost double the time spent face-to-face with patients. Administrative burdens account for nearly nine hours of a physician’s work week.

On top of this are productivity quotas, limited appointment slots, and rising patient expectations fueled by the internet and supercharged now by AI. Many physicians feel they are working on an assembly line that was designed for throughput rather than thoughtful care.

Add diagnostic uncertainty (conditions and symptoms that are not revealed on labs or imaging) and it becomes clear how communication breakdowns occur.

None of this excuses dismissal. But without understanding the system clinicians operate in, we cannot meaningfully address the problem.

Where communication goes wrong

Three common breakdowns contribute to the feeling of gaslighting:

• Interruptions: Studies show physicians interrupt patients within 11-18 seconds. Patients feel unheard; physicians feel they’re being efficient.
• Reassurance given too early: When doctors say “Everything looks fine,” patients may hear, “There’s nothing wrong; it’s all in your head.” Most clinicians mean, “The tests don’t show immediate danger,” but without explanation, the reassurance might be experienced as dismissal.
• Implicit bias: Unconscious assumptions (about pain tolerance, emotional stability, weight, gender, race, or mental health) shape how symptoms are interpreted. These biases are real, measurable, and correctable, but only if we acknowledge them.

When gaslighting happens: what patients can do

Patients often ask me, “What do I do now?” The key is to remain organized, clear, and collaborative while firmly advocating for yourself. In all cases, be respectful.

• Prepare before the visit: Bring a concise, written list of your symptoms, when they began, what makes them better or worse, and what worries you most. Start the appointment by handing this list to your clinician.
• Use calm, assertive language (“I” sentences): A few phrases can shift the tone immediately:
  • “I understand anxiety could play a role, but I’d also like to explore other possible causes.”
  • “Before we move on, I’d like to finish explaining what I’m experiencing.”
  • “Could we review what has been ruled out and what remains to evaluate?”
• Redirect if you’re interrupted: If you’re cut off, say, “I’ll get to that point, but I’d like to finish this thought first.”
• Ask clarifying questions: These prompt partnership:
  • “What serious conditions have we ruled in or out?”
  • “What test or exam would help clarify this diagnosis?”
  • “If my tests are normal but I still have symptoms, what’s the next step?”
• Bring an advocate: A family member or friend can help keep the conversation balanced. While not an advocate per se, use your cellphone to record the encounter so you and a family member or friend can review together at a later time.
• Seek a second opinion if needed: This is your right. A clinician who is secure in their work will not be threatened by it.

A simple letter patients can use

Sometimes putting concerns in writing can redirect the entire dynamic. Here is a concise, patient-friendly template suitable for a portal message or printed note:

Subject: Clarifying my symptoms and next steps

Dear Dr. [Last Name],
Thank you for your care so far. I’m writing to clarify my concerns and ensure we’re aligned.
I understand that [working diagnosis] has been considered, but based on [brief symptom description], I would like to explore additional possible causes as well.
At our next visit, could we review:
1. What findings support the current working diagnosis
2. What other explanations we should consider
3. What steps (tests, referrals, follow-up) might help clarify the picture
I value your expertise and want to work together as partners in my care. I will bring notes about my symptoms so we can review them together.

Thank you for your time.

Sincerely,
[Your Name]

Moving forward: a true partnership, not a power struggle

Medical gaslighting is not simply a matter of individual behavior; it is a systemic and cultural issue that impacts both sides of the exam table. Patients need to feel heard. Physicians need the space and support to listen. Empathy should not be luxury.

When we begin with empathy and understanding, when clinicians slow down just enough to listen, and patients come prepared to participate, the partnership grows stronger.

Ultimately, both patients and physicians want the same thing: to be seen, heard, and taken seriously, and for you to have the best clinical outcome.

That’s the way medicine was always intended to be: a true partnership.

Alan P. Feren is a retired surgeon, independent physician, health care consultant, and patient advocate with more than 50 years of experience in clinical practice, system leadership, and health care innovation. Formerly in academic and community surgical practice, he has worked across the evolving landscape of managed care and clinical governance.

In the 1990s, Dr. Feren co-authored clinical guidelines that evolved into what is now MCG Health, now used by more than 80 percent of U.S. health plans and over 3,100 hospitals. He has advised health technology startups, helped shape managed care policy, and served as a clinical content developer for health care technology platforms.

His work centers on restoring shared understanding between clinicians and patients in an era defined by speed, fragmentation, and technological mediation. Drawing on both professional experience and his own journey as a complex patient, he writes about transparency, accountability, and the disciplined methods that make medical care trustworthy. He is a contributor to KevinMD and a podcast guest. More information is available at mypersonaladvocate.net and on LinkedIn.