‘Medical Gaslighting’ Tops ECRI’s List of Top Patient Safety Threats

Dismissing patient, family, and caregiver concerns tops ECRI’s 2025 list of the most significant threats to patient safety. The healthcare safety nonprofit organization says 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.   
 
More than 94% of patients reported instances when their symptoms were ignored or dismissed by a doctor, according to a survey from HealthCentral. ECRI says when concerns go unaddressed, patients and caregivers feel like they’re experiencing “medical gaslighting,” which the American Journal of Medicine defines as “an act that invalidates a patient’s genuine clinical concern without proper medical evaluation.” Unlike the popular usage of the term “gaslighting,” medical gaslighting is not considered intentional, and clinicians are often unaware they exhibit the behavior, ECRI experts say.
 
ECRI says medical gaslighting can happen when clinicians are rushed for time, have biases that reflexively attribute symptoms to issues like mental illness, age, or weight, or make cognitive errors like interpreting new information in a way that confirms a previous diagnosis. This can lead to a missed diagnosis, delayed treatment, and decreased trust between patients and their healthcare providers.
 
“Most clinicians have a deep commitment to healing and protecting their patients and would never intentionally make a patient feel unheard, but it nevertheless happens with alarming frequency,” said Marcus Schabacker, M.D., Ph.D., president and CEO of ECRI, in a statement. “Providing high-quality healthcare starts with truly listening to patients. When we value their input, we gain critical insights that improve patient outcomes and build trust. A healthcare system that prioritizes patient voices is one that delivers safer, more efficient, and more compassionate care for all. Unfortunately, too many clinicians are operating under time and resource constraints that fuel substandard care.”
 
ECRI experts say solutions require a holistic approach that considers how all aspects of a health system—including leadership and governance structures, patient engagement, workforce wellness, and training infrastructure—promote safety.
 
ECRI offers systems-based recommendations to help clinicians actively involve patients in their care, including examining scheduling policies to ensure clinicians have enough time with patients, using empathetic listening techniques, and providing education on conditions that are often misunderstood or minimized, like endometriosis.
 
The report provides similar systems-based solutions for each of the top 10 concerns. The 2025 concerns in ranked order are:

1. Dismissing patient, family, and caregiver concerns
2. Insufficient governance of artificial intelligence
3. Spread of medical misinformation
4. Cybersecurity breaches
5. Caring for veterans in non-military health settings                           
6. Substandard and falsified drugs
7. Diagnostic error in cancers, vascular events, and infections
8. Healthcare-associated infections in long-term care facilities
9. Inadequate coordination during patient discharge
10. Deteriorating working conditions in community pharmacies
 
ECRI’s 2025 report includes recommendations for healthcare organizations to create organizational resilience to navigate the identified threats and strive for total systems safety.