The Negative Consequences of Invalidating Patients' Symptoms
Patients suffer when clinicians dismiss, ignore, or minimize symptoms.
Posted May 29, 2025 | Reviewed by Margaret Foley
Just about any patient with a chronic illness has probably seen a healthcare professional who dismissed their symptoms. Statements meant to be reassuring, like “it’s probably nothing,” communicate to patients that their concerns are being minimized. But while patients may post about "medical gaslighting " online, to date, it’s been hard to quantify the impact of being dismissed at healthcare visits.
A new review paper by Rutgers Health researchers concludes that when patients’ symptoms are ignored, dismissed, or minimized, they suffer harmful consequences. These consequences may include worsening medical conditions due to a delay in diagnosis, feelings of shame and self-doubt, or loss of trust in clinicians, as well as behaviors like avoiding medical care. At worst, patients whose symptoms are dismissed by clinicians may become suicidal.
Medical gaslighting and difficult-to-diagnose diseases
The paper in Psychological Bulletin was a meta-synthesis of 151 qualitative studies representing 11,307 individuals with difficult-to-diagnose conditions. It’s worth listing these conditions in full, in order to validate readers who have or know someone who has them. The individuals in the review had Ehlers-Danlos syndrome, endometriosis, fibromyalgia syndrome, Gulf War syndrome, irritable bowel syndrome, long Covid , multiple chemical sensitivity, myalgic encephalomyelitis/chronic fatigue syndrome, postural orthostatic tachycardia syndrome (POTS), systemic lupus erythematosus, and vulvodynia.
The authors write, “In recent years, there has been an upsurge in the prevalence of contested, ambiguous, and difficult-to-diagnose illnesses. In fact, health care interactions in which there is no known diagnosis is the fastest growing type of medical visit. This creates uncertainty for physicians who may respond by dismissing or minimizing patients’ symptoms.” This is particularly true of the last five years, because Covid infection is a known trigger for a number of the studied conditions, including long Covid and POTS.
When patients with these conditions try to describe their symptoms, which are complex and variable, they are all too often met with medical gaslighting. “We found that patients can question reality,” said Allyson Bontempo, a postdoctoral fellow at Rutgers Robert Wood Johnson Medical School and lead author of the review, in a press release . “They ask, ‘Am I making this up? Is this all in my head?’ We also found symptom invalidation is associated with depression , suicidality and health care-related anxiety that actually can rise to the level of trauma responses.”
In addition, Bontempo said many patients behave differently with clinicians or avoid healthcare after experiencing invalidation. “Patients reported downplaying their symptoms to doctors so they wouldn't appear dramatic or like they're exaggerating,” she said. “One patient had said that they refuse to go in even if it's not related to [their] endometriosis.”
Medical culture and the need for certainty
Healthcare professionals face pressure to know the answer and fix the problem right away. This pressure comes from the powers that be, such as insurance companies and healthcare organizations that favor the use of algorithms that feed into tests and medications with preferred pricing. The pressure may also come from the expectations of patients or the social narratives we favor about doctors. Consider medical dramas, where the hero, whether doctor or nurse, knows the answer even when no one else does. Even HBO’s The Pitt, considered by many to be the most accurate medical drama ever made, presented easily recognizable textbook versions of medical conditions with clear, available treatments.
This need for certainty may also have been drilled into healthcare professionals in their training years. “In medical education , managing uncertainty and tolerance for ambiguity are often taught indirectly through observation, role modeling, and informal curricular experiences” (Helou, 2020). The problem is that what you learn will depend on your role models. And formal teaching to give medical trainees a model for managing uncertainty has not been part of medical training.
Another factor that contributes to health professionals dismissing certain symptoms also starts in medical training. Students learn to speak the language of medicine, to take a patient’s story and extract the data medicine cares about, and disregard the data it doesn’t (Smedley, 2003). The goal is pattern recognition : to see the pattern in the timing and nature of the symptoms that points to the diagnosis. But what happens when the healthcare provider is dealing with a disease they have never heard of, or one that has not been named and studied yet?
Historically, the medical establishment has long offered a solution for any patient who doesn't fit into the diagnostic box, one that any review of medical history will find everywhere: If you don't understand their symptoms, it's probably psychological. It was not that long ago that patients with multiple sclerosis were told they had mental disorders and sent to psychiatrists. These days, patients with postural orthostatic tachycardia syndrome (POTS), which happens when the autonomic nervous system struggles to maintain blood pressure while standing up, are often told that their near-fainting episodes and rapid heart rates are simple anxiety.
What clinicians can do when they face uncertainty
When someone has a difficult-to-diagnose disease, they fundamentally need to hear validation from their healthcare providers that their suffering is real. Even when a clinician cannot diagnose the condition, the study recommends providing validation.
“I don't recommend reassurance about it ‘probably being nothing serious’ to patients who have a lot of distress about their symptoms,” Bontempo said. “Patients appreciate clinicians communicating their uncertainty and admitting they don’t know something.”
What patients can do about medical gaslighting
While checking clinicians’ ratings and reading the comments about them can sometimes be helpful, sometimes well-loved clinicians with great ratings can be invalidating about difficult-to-diagnose conditions. That cardiologist who is wonderfully empathetic to folks with congestive heart failure may also tell a patient with POTS that it’s all in their head.
“It's hard for patients to be in a situation like this where they must advocate for themselves so aggressively," said Bontempo. “One good strategy is to bring a partner, an adult child, a friend or anyone else who can support their statements about symptoms when talking to clinicians.”
Bontempo, A. C., Bontempo, J. M., & Duberstein, P. R. (2025). Ignored, dismissed, and minimized: Understanding the harmful consequences of invalidation in health care—A systematic meta-synthesis of qualitative research. Psychological Bulletin, 151 (4), 399–427. https://doi.org/10.1037/bul0000473
Helou MA, DiazGranados D, Ryan MS, Cyrus JW. Uncertainty in Decision Making in Medicine: A Scoping Review and Thematic Analysis of Conceptual Models. Acad Med. 2020 Jan;95(1):157-165. doi: 10.1097/ACM.0000000000002902. PMID: 31348062; PMCID: PMC6925325.
Smedley BD, Stith AY, Nelson AR, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Washington (DC): National Academies Press (US) ; 2003.
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Alison Escalante, M.D., is a pediatrician, speaker, and author of Sigh, See, Start: How to Be the Parent Your Child Needs in a World That Won’t Stop Pushing .
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