When doctors dismiss symptoms, patients can suffer lasting harm

A review by Rutgers Health researchers reveals the psychological damage and health care avoidance that may occur when doctors dismiss, minimize or ignore patients’ symptoms, a phenomenon medical scientists call “symptom invalidation” and patients often call “medical gaslighting.”

The paper in Psychological Bulletin examined 151 qualitative studies representing more than 11,000 individuals with conditions, including fibromyalgia, long COVID, endometriosis, lupus and other difficult-to-diagnose illnesses.

“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. “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.”

The research identified four broad categories of harm: emotional states such as self-doubt and shame; health care-specific emotional responses, including loss of trust in clinicians; behavioral changes such as avoiding medical care; and diagnostic delays that can worsen conditions.

Bontempo said many patients alter their behaviors with clinicians after experiencing invalidation.

“Patients reported downplaying their symptoms to doctors so they wouldn’t appear dramatic or like they’re exaggerating,” she said.

Some patients avoid health care entirely, even for unrelated conditions.

“One patient had said that they refuse to go in even if it’s not related to endometriosis,” Bontempo said.

Encounters in which no clear diagnosis exists are now the fastest‑rising category of medical visit, propelled by conditions such as long COVID and postural orthostatic tachycardia syndrome, which causes lightheadedness and other symptoms upon standing, according to the paper.

Members of Bontempo’s team argued that symptom invalidation is so common because medical training hasn’t kept pace with increasing uncertainty. Algorithm‑driven workflows leave little room for listening to complex stories that don’t fit neatly into test panels or insurance codes.

The study offers guidance for health care providers facing diagnostic uncertainty. Bontempo recommends that clinicians validate patients’ experiences regardless of whether they can diagnose them.

“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.”

The researchers said they hope the findings will lead to interventions that prevent symptom invalidation and improve psychological and physical health outcomes.

For patients experiencing symptom invalidation, the research suggests self-advocacy may help, though Bontempo said this is often challenging.

“Patients can do research and see if they can find ratings of the clinicians online,” she said. “But it’s hard for patients to be in a situation like this where they must advocate for themselves so aggressively. 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.”