Patients with chronic, complex conditions that are difficult to diagnose can face another challenge in the healthcare system: having their symptoms minimized, misattributed or invalidated by clinicians, according to an Oct. 1 article in the American Psychological Association’s Monitor on Psychology.
Research has linked these experiences to self-doubt, psychological distress, reduced trust in healthcare and delays in treatment. Psychologists are examining how stigma and medical invalidation affect patient behavior and what clinicians can do to strengthen patient-provider relationships.
Here are five lessons for healthcare leaders and clinicians on stigma and health psychology in patient care:
1. Symptom invalidation can affect whether patients seek care. Patients who repeatedly feel dismissed may begin to doubt their own experiences, experience shame or avoid healthcare altogether. Research has also linked medical invalidation with healthcare anxiety and diagnostic delays. For some patients, repeated invalidation can contribute to medical trauma and post-traumatic stress disorder-like symptoms.
2. Diagnostic uncertainty can create conditions for stigma. Tens of millions of people in the U.S. have chronic, complex conditions that lack clear biomarkers or definitive diagnostic tests, including fibromyalgia, long COVID, endometriosis, chronic fatigue syndrome and autoimmune disorders. In 2021, conditions not easily designated as a particular illness accounted for 15% of U.S. medical services spending, the largest share of any category and more than twice that of cancer, according to KFF data cited in the article.
3. The burden of invalidation is not distributed equally. Women, people of color and people with higher weight can face additional structural inequities and stigma in healthcare. Endometriosis illustrates the potential consequences: The condition affects up to 10% of women, yet the average diagnosis comes five to 12 years after symptoms begin, with most patients consulting three or more healthcare professionals.
4. Clinicians can acknowledge uncertainty without dismissing patients. Psychologists recommend that clinicians be transparent when they do not know the cause of symptoms while continuing to investigate them. Avoiding unwarranted reassurance and acknowledging the limits of current understanding can help patients feel heard even when clinicians cannot provide an immediate diagnosis.
5. Health psychologists can help rebuild trust in healthcare. Psychologists can work with patients to address internalized stigma, develop self-advocacy skills and process medical trauma. They can also work with clinicians and health systems on trauma-informed care, communication strategies and education about how stigma and symptom invalidation can affect patients.
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