The risks associated with medical professionals dismissing patient, family and caregiver concerns — also called “medical gaslighting” — ranked highest on an annual list of patient safety concerns compiled by the nonprofit organization ECRI. Insufficient governance of AI in health care, the viral spread of medical misinformation, and medical errors and delays in care resulting from cybersecurity breaches also were listed as significant concerns.
Paying close attention to the items on the list can help journalists better understand the patient safety field or prompt questions to ask when reporting on stories related to patient safety and health information technology. Journalists also can get story ideas by reviewing ECRI’s evidence-based recommendations for health systems listed in their report related to each safety concern.
The No. 1 safety concern
More than 94% of people responding to a 2023 survey about medical gaslighting reported instances in which they felt their symptoms were ignored or dismissed by a doctor, the report authors said.
It’s been 25 years since the Institute of Medicine published its “To Err is Human” report spelling out strategies to reduce preventable medical errors, said Marcus Schabacker, M.D., Ph.D., ECRI’s president and CEO, during a March 18 webinar discussing the dismissal of patient concerns.
“While we have made some progress in some areas, it is still shocking to me, quite honestly, how many patients we still harm who are in our care,” he said, noting that other high-risk industries, such as aviation and nuclear power have adopted a systems-thinking approach to solving problems, which considers all parts of an issue. By contrast, he said, health care is “making the human adhere to a system, rather than designing a system which acknowledges and takes into account the fallibility of the human.”
Despite “all the work that is happening to activate patients and families as partners in care, there is still much work to do,” said Shannon Davila, executive director of total systems safety at ECRI, in the webinar. “Patients are still not being heard in the way that they should. Everyday, someone is experiencing a feeling of not having their needs or concerns addressed.” While health care providers come to work wanting to do their best, she said, misaligned work processes may not facilitate patient-centered care.
Medical gaslighting demeans patients
Dismissing patient concerns can arise from a clinician’s preconceived ideas about specific symptoms, misunderstandings of certain medical conditions and unconscious biases, Davila said. Cognitive bias exists when clinicians make an error in thinking by misinterpreting information. Someone may think they’ve seen a certain condition many times before, so they may overlook what a patient is trying to communicate.
Medical gaslighting includes actions such as ignoring or interrupting patients, minimizing the severity of symptoms, and refusing to order follow-up tests, all of which can lead to misdiagnosis, delayed treatment and emotional distress, Davila said. “Patients who experience medical gaslighting are at risk of losing trust with their providers and the health care industry and are less likely to seek care in the future,” she said.
Governance of AI, medical errors, misinformation also cited
Nine additional concerns were listed in the report, along with recommendations for health systems to address these items to improve patient safety.
Insufficient governance of artificial intelligence in health care (#2). AI is being implemented into a growing array of health care applications, including imaging applications, clinical decision-making support tools, medical note generators and more, the authors wrote. While these applications have many potential benefits, such as reduced costs and provider burnout, concerns surrounding bias, transparency and privacy/security remain. Medical errors generated by AI could compromise patient safety and lead to misdiagnosis and inappropriate treatment decisions, resulting in injury or death. In a 2023 survey of 31 hospitals, only 16% reported they had a systemwide governance policy for AI usage and data access.
Wide availability and viral spread of medical misinformation (#3). Medical misinformation is widely available and being dispersed further and faster than before, wrote the authors. This misinformation may lead to patients requesting ineffective or dangerous treatments or cause patients to forgo proven effective treatments. During July-December 2022, an estimated 59% of U.S. adults searched for medical information online, making it vital to push health literacy and for health care professionals to collaborate with patients to make sound, informed decisions.
Medical errors and delays in care resulting from cybersecurity breaches (#4). Cybersecurity breaches can cause widespread disruptions with broad, devastating impacts on patients, providers, health care organizations and the surrounding community. Patients can experience poor outcomes from delays in tests and procedures, more complications from medical procedures, more transfers and higher mortality rates, according to one recent report. They may also have their personal information exposed. Compromised access to prescription medications is also a concern, which can lead to missed doses.
Unique health care challenges caring for veterans (#5). Veterans have unique, complex health issues including physical and emotional injuries resulting from their military service. However, the majority of veterans do not receive health care through the Veterans Health Administration and in care settings where providers are not properly trained to assess and treat their issues, veterans are at risk for potential missed diagnoses and inadequate care, the authors wrote. One study found that among 104 medical schools, only 31% included content about cultural competence for veterans in their curricula.
Threat of substandard and falsified drugs (#6). Counterfeit drugs made to resemble genuine pharmaceuticals have become a big business globally, the authors noted, worth as much as $431 billion a year. Medications are increasingly purchased from unregulated online marketplaces; 95-96% of online pharmacies selling prescription drugs operate illegally. These drugs are frequently adulterated with potentially lethal ingredients such as fentanyl or may lack the active ingredients needed to be effective.
Diagnostic errors in cancers, major vascular events and infections (#7). Misdiagnosis of cancers (37.8%), vascular events (22.8%) and infections (13.5%) account for the majority of high-severity harm to patients, most commonly lung cancer, stroke and sepsis, the authors wrote. Other commonly misdiagnosed conditions include breast, colorectal, prostate and skin cancers, heart attack and meningitis. Diagnostic errors result from a range of factors from clinical assessment to failure to order or process lab tests.
Persistence of health care-associated infections (HAIs) in long-term care facilities (#8). An estimated one in 43 nursing home residents contracts an HAI every day, the authors noted. Many infections are caused by multidrug-resistant organisms, which can cause severe illness, sepsis or death.
Inadequate communication and coordination during discharge (#9). A majority of communication failures occur during patient handoffs, including discharge, the authors said. When managed poorly, transitions can lead to adverse events and poorer health outcomes, worsened physical conditions, emotional distress and increased health care costs.
Deteriorating community pharmacy working conditions (#10). Community pharmacists have seen an increase in requests for vaccinations and point-of-care testing while staffing has not always adjusted, leaving professionals to rush to administer vaccines and verify and dispense prescriptions, or multitask and verify prescriptions while on a phone call. This can lead to stress and burnout for pharmacy staff and medication errors for patients.
Project PIVOT — a program from the Patients for Patient Safety US focused on improving patient safety, diagnostic safety and equity by learning from patient experiences.
Karen Blum is AHCJ’s health beat leader for health IT. She’s a health and science journalist based in the Baltimore area and has written health IT stories for numerous trade publications.
