Dismissive medicine and gaslighting of patients by physicians – A bioethics lens

Abstract

Objectives

This Discussion paper seeks to raise awareness of the phenomena of dismissive medicine (DM) and medical gaslighting (MG) and their underlying threats to principles of Bioethics. DM refers to mistreatment and negative patient-physician interactions. In most studies on DM, patients perceived physicians as invalidating their illness, as uniformed, as blaming and stigmatizing them, misunderstanding their condition, insensitive, rushing the visit, refusing to discuss pain, rude, and failing to maintain eye contact, listen, and to provide appropriate information about causes and treatments. A special case of DM is MG, referring to the experience of patients when their medical complaints and suffering are discounted, doubted, questioned, second guessed, or denied by physicians causing patients self-doubts. DM and MG may occur, at times, unintentionally Durbhakula and Fortin [1] and Fielding-Singh and Dmowska [2], resulting in severe ramifications. Surprisingly, existing reports focused on the clinical, economic, psychological, and emotional ramifications of DM and MG (Braeuninger-Weimer et al., 2019; Burke, 2019; Street et al., 2019; Merone et al., 2022; Claréus and Renström, 2019; Sheehan, 2020; Turan et al., 2019; Penner and Paul, 2017; Au et al., 2022; Dolezal, 2022; Shapiro and Hayburn, 2024; Fuss et al., 2024; Hunt, 2022) [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], rather than on the infringement of bioethics, which is the focus of this Discussion paper.

Conclusions

DM and MG not only cause patients to feel stigma, prejudice, shame, and blame, and develop fear of seeking clinical help but also, constitute infringements of beneficence, non-malfeasance, respect for patient right of autonomy, and distributive justice in patient care. This Discussion paper calls for more education about the implicit ethical aspects of these phenomena and policy modifications to efface DM and MG.