Clinicians’ increased burdens are making it harder for valid concerns voiced by patients, their families and their caretakers to be acknowledged, raising the risk of missed diagnoses and exacerbated health disparities, the ECRI warned in a new report.
An annual ranking of the top 10 patient safety concerns, released Monday by the healthcare quality and safety group and its Institute for Safe Medication Practices (ISMP) affiliate, places dismissed concerns above other issues like insufficient artificial intelligence governance and medical misinformation.
Specifically, it points to a 2023 survey in which 94% of respondents reported instances in which they felt their symptoms were being ignored or dismissed by a doctor—leading to an experience the group referred to as “medical gaslighting,” in reference to when an individual is manipulated in questioning their perceptions.
Clinicians who are medical gaslighting may minimize the severity of a patient’s symptoms, ignore or interrupt patients, blame the patient and generally exhibit condescending behavior, the group warned.
Fifty-eight percent of those responding to the survey said their symptoms worsened after a doctor dismissed their concerns, and 28% said they experienced a health emergency as a result of their provider’s lack of response.
Beyond the risk of missed diagnoses, the ECRI pointed to data suggesting that medical gaslighting is more commonly experienced by certain patient populations, such as Black patients and women.
The ECRI softened its finger-pointing at clinicians, writing that “medical gaslighting is not driven by an intentional desire to manipulate patients, and clinicians may not be aware they are exhibiting gaslighting behavior. Dismissing patient concerns can also arise from a clinician’s preconceived ideas about specific symptoms, misunderstandings of certain medical conditions, unconscious biases, challenges regarding causes for nonspecific complaints, or cognitive biases in clinical decision-making.”
To help these clinicians recognize their biases, the group recommended open conversations on medical gaslighting between leadership and staff, prioritizing workforce diversity and inclusion, limiting staff’s use of “never words” (e.g., Let’s not worry about that now), use of simulation training and the use of tools and processes that encourage patient communication.
More broadly, the ECRI also advocated for organizational scheduling that reduces clinicians’ burden and gives them “the appropriate amount of time” to hear, process and respond to concerns.
“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,” Marcus Schabacker, M.D., Ph.D., president and CEO of the ECRI, said 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,” he continued. “Unfortunately, too many clinicians are operating under time and resource constraints that fuel substandard care.”
The full list of top patient safety concerns for 2025 as listed by the ECRI and the ISMP, in ranked order, was:
- Risks of dismissing patient, family and caregiver concerns
- Insufficient governance of AI in healthcare
- The wide availability and viral spread of medical misinformation
- Medical error and delay in care resulting from cybersecurity breaches
- Unique healthcare challenges in caring for veterans
- Substandard and falsified drugs
- Diagnostic errors related to cancers, major vascular events and infections
- Persistence of healthcare-associated infections in long-term care facilities
- Inadequate communications and coordination during discharge
- Deteriorating community pharmacy working conditions, which contribute to medication errors and worsened patient and staff safety
The ECRI and the ISMP built the annual list and report by polling members and reviewing millions of logged patient safety events alongside other literature on patient safety. A cross-disciplinary team of experts from the groups then ranked nominees identified in the review based on the criteria of severity, frequency, breadth, insidiousness and organization pressure.
The full report includes recommendations for healthcare organizations looking to address each of the 10 issues.
Last year’s list was headlined by the difficulties new graduates faced when taking their first steps into the healthcare workforce. That challenge as well as several others on the 2024 list largely underscored safety issues stemming from an industrywide shortage of well-trained and experienced clinicians.