Seraina Petra Lerch

Objective Research on patients feeling that their symptoms are not taken seriously (medical invalidation) has predominantly focused on individual diseases. This study explored patients' experiences across different medical conditions and healthcare contexts to identify common characteristics, contributing factors, consequences, and opportunities for prevention. MethodsThe study was conducted in Germany between January and March 2025 using interviews undertaken remotely or in person. Data were analysed using qualitative content analysis following Kuckartz and Rädiker. Thirty-one adults (≥18 years) with self-reported experiences of not being taken seriously in healthcare were purposively recruited through patient organisations and social media to achieve maximum variation regarding symptoms and diagnoses.ResultsParticipants described not being taken seriously as a cross-cutting healthcare phenomenon occurring across diverse symptoms, diagnoses, medical specialties, and healthcare settings. Experiences ranged from isolated encounters to cumulative processes that developed over repeated interactions with healthcare professionals (HCPs). Contributing factors were perceived at multiple levels, including healthcare system, HCPs, patient, disease, and interactional factors, which frequently interacted. Consequences extended beyond the initial consultation and included psychological distress, loss of trust, delayed or inappropriate diagnosis and treatment, reduced healthcare utilisation, occupational consequences, and impaired social well-being. Participants identified opportunities for prevention at different levels, highlighting structured feedback mechanisms. ConclusionsMedical invalidation is a multifactorial phenomenon that extends across diseases and healthcare settings. Patients emphasized that medical invalidation depends not only on clinical decision-making but on being heard, having their illness perceptions acknowledged, and receiving transparent communication. Strengthening these elements of patient-centred care may improve healthcare experiences.

Background: Medical invalidation, medical gaslighting, and related constructs have gained visibility in public discourse but remain inconsistently defined in scientific literature. Despite growing research—often focused on specific diseases— to date, no single review has comprehensively synthesized their definitions, causes, consequences, or methods of measurement. This scoping review addresses this gap by examining medical invalidation and related constructs. Methods: Using a preregistered protocol, we systematically searched PubMed, CINAHL, Web of Science, Google Scholar, and ProQuest (dissertations) without year restrictions. Eligible sources included peer-reviewed empirical, theoretical, and conceptual work in English addressing invalidation, gaslighting, or closely related notions within healthcare. A total of 158 studies were identified through database searches and citation tracking. Data extraction followed a standardized schema, and findings were synthesized descriptively and through thematic analysis to clarify terminology, map determinants and outcomes, and identify existing measurement approaches. Results: The results showed substantial inconsistency in how “invalidation,” “not being taken seriously,” and “gaslighting” were defined. Medical invalidation emerged as a multifactorial phenomenon driven by diagnostic challenges, structural and societal factors, provider and patient characteristics, stigma, misattribution, interactional dynamics, academic knowledge gaps, and disease-related complexity. Invalidation was associated with wide-ranging behavioural, emotional, cognitive, physical, relational, and systemic harms, while validation had consistently beneficial effects. Proposed solutions in the summarized studies included communication improvements, clinician training, patient support, targeted research, and structural and systemic changes. Discussions: Medical invalidation represents a complex, systemic issue with significant implications for patient safety. The discussion highlights its multifactorial origins, its potential to cause both psychological and physical harm, and the need for clearer conceptualisation within the field. Advancing research requires validated instruments and longitudinal designs to examine underlying mechanisms and consequences. Addressing medical invalidation will demand multi-level interventions to improve communication, reduce structural barriers, and promote equitable, patient-centred care. OSF Preregistration: https://doi.org/10.17605/OSF.IO/MPE6U

Post-acute immune-mediated syndromes (PAIMS), including Long COVID/Post-COVID (LC/PC), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and post-acute COVID-19 vaccination syndrome (PACVS), are characterized by persistent, multisystemic symptoms and significant healthcare challenges. A key issue is medical invalidation, defined as the dismissal or delegitimization of patients’ reports of symptoms. This cross-sectional online study, conducted in Germany between October and December 2025 ( N = 577), examined healthcare experiences, access barriers, and perceived invalidation. Although healthcare utilization was high, 87% of participants reported difficulties accessing appropriate treatment. Major barriers included lack of available therapies (60%) or not being taken seriously (26%). Perceived invalidation by medical personnel was moderate across all groups (LC: M = 2.80; ME/CFS: M = 2.99; PACVS: M = 3.03) and did not differ significantly (Welch-F(2, 190.50) = 2.87, p = 0.059) between groups. Invalidation occurred not only within healthcare settings but was particularly pronounced in interactions with authorities and workplaces. Social media and online communities served as important sources of information and support, especially among individuals with ME/CFS. Overall, the findings reveal substantial structural barriers in the care of PAIMS and highlight the need for improved clinical education, better care coordination, and stronger institutional recognition of these conditions.

The growing integration of digital technologies into healthcare requires understanding the impact of different consultation modalities on patient stress, memory and perceived credibility. This study compared different consultation modalities (human physician, in person or via video call; AI-style physician, as a chatbot or avatar) in standardized simulated medical consultations involving the delivery of bad news. For the AI-styled physician consultations, a Wizard of Oz design was used, in which participants were told they interacted with an AI physician while a human controlled the interaction. 163 healthy participants experienced either a human or an AI physician. Stress was measured through ratings and salivary cortisol, alongside memory retrieval and situation credibility. Human-based consultations led to higher stress levels than AI-styled formats. Greater perceived credibility was associated with stronger stress responses. Memory retrieval was lowest in the AI-styled chatbot condition. These findings show that different consultation modalities are associated with varying levels of stress and memory in medical settings. AI-styled physician interactions may reduce stress in routine medical communication, but their use should be carefully considered for critical medical communication.

Zusammenfassung: Genomisches Neugeborenen-Screening (gNBS) wird international zunehmend diskutiert und in Forschungsprojekten getestet. Es bietet das Potenzial, zahlreiche genetische Erkrankungen frühzeitig zu erkennen, birgt jedoch gleichzeitig ethische und psychologische Herausforderungen. Diese Arbeit widmet sich der Frage der Autonomie bei der elterlichen Entscheidungsfindung im Kontext von gNBS. Zunächst werden ethische und psychologische Dimensionen der Entscheidungsfindung beleuchtet. Die ethische Herausforderung besteht nicht nur darin, komplexe Informationen verständlich aufzubereiten, sondern auch sicherzustellen, dass Eltern die Tragweite ihrer Entscheidung für oder gegen das Screening vollständig erfassen können. Besonders herausfordernd ist dabei, dass sie eine Entscheidung im Namen ihres Kindes treffen müssen, die dessen zukünftiges Wohlergehen maßgeblich beeinflusst. Psychologische Faktoren wie individuelle Persönlichkeitsmerkmale, Vertrauen in den Arzt oder die Ärztin, sowie momentane Emotionen können die Entscheidungsfindung ebenfalls beeinflussen. Diese Arbeit nimmt Bezug auf die Ergebnisse einer Fokusgruppenbefragung, in der die Ansichten und Bedürfnisse von Eltern, Ärztinnen und Ärzten sowie Patientenvertreter-/innen zur Entscheidungsfindung beim gNBS erfasst wurden. Die Befragten betonten den Bedarf an frühzeitiger, pränataler Aufklärung und struktureller Unterstützung im Einwilligungsprozess. Es zeigte sich, dass Fachkompetenz der aufklärenden Personen und die Berücksichtigung unterschiedlicher Betreuungskontexte entscheidend sein könnten, um eine informierte und autonome Entscheidung der Eltern zu gewährleisten. Empirische Befunde und theoretische Überlegungen münden in praktische Empfehlungen: Informationen sollten klar, verständlich und frühzeitig zur Verfügung gestellt werden. Interaktive und adaptive Entscheidungshilfen, Schulungen für Gesundheitspersonal und ein transparenter Informationsprozess sind essenziell, um Eltern bei der Entscheidungsfindung zu unterstützen. Dabei steht die Autonomie der Eltern in einem Spannungsverhältnis zur stellvertretenden Wahrnehmung der Autonomierechte des Kindes: Während Eltern befähigt werden sollen, eine informierte und eigenständige Entscheidung zu treffen, ist sicherzustellen, dass diese Entscheidung im besten Interesse des Kindes erfolgt. Das Kindeswohl muss dabei Vorrang vor rein elterlichen Interessen haben.

The advancement of genome sequencing technology and its potential application in newborn screening is being discussed in various countries. Genomic newborn screening (gNBS) can provide parents with information about their child's genetic susceptibility for known disorders. However, it also presents ethical and psychosocial challenges. This study was carried out with a view toward the possible introduction of gNBS in Germany. Due to the existing challenges, it is crucial to understand different perspectives of relevant groups in Germany before implementing gNBS. Four online focus groups were conducted with parents, patient representatives, and healthcare professionals to explore perceived opportunities and challenges, as well as needs regarding a potential gNBS program. Discussions with altogether 24 participants were semi‐structured using a pre‐defined interview guide. Sessions were audio‐visually recorded and transcripts were analyzed using a structuring qualitative content analysis combining both deductive and inductive methods. Participants expressed positive views about gNBS but also reservations about a gNBS program and posed requirements for operating conditions. One salient theme that emerged was hope for certainty through gNBS in the face of numerous uncertainties. The study complements the perspective of patient representatives, providing further insight into the subject matter. This is a valuable contribution as they possess a comprehensive understanding of the medical, psychological, and ethical considerations involved. Patient representatives placed particular emphasis on the advantages of avoiding a diagnostic odyssey and the significance of support systems. The results provide first insights into different views on gNBS in Germany. These views can inform the potential preparation of a gNBS program in Germany, particularly with regard to information and consent requirements. Implications for practice, such as informing and educating parents about gNBS during pregnancy, can be derived from the study.

Purpose: Negotiating the balance between clinical residents’ roles as health care practitioners and learners is a struggle in postgraduate medical education. Although ad hoc entrustment has been studied in this context, little is known about residents’ perceptions of ad hoc over- and underentrustment, the need for supervision, and their coping strategies. Therefore, this study explored residents’ perspectives concerning these topics. Method: The authors conducted semistructured, in-depth interviews with 12 purposively sampled residents in the graduate medical educational phase of residency who were involved in geriatric psychiatry rotations from different training sites and settings in Switzerland. The interviews were conducted between January and March 2022. Researchers used a thematic analysis to explore and interpret the data within a constructivist research paradigm. Results: Four overarching themes were identified: ad hoc and default entrustment in the workplace, perceptions of supervision, applied coping strategies to over- and underentrustment, and suggestions for improvement. Residents described entrustment decisions in the workplace as a default, often covert process and as an explicit, ad hoc delegation of clinical tasks. Perceived optimal supervision entailed sufficient time, frequency, and availability of the supervision, supervisors referring to scientific evidence in their reasoning, trustworthiness, and a psychologically safe learning environment. Residents described suboptimal supervision as lacking appropriate feedback timing, having little or nonexistent time in general, using an ambivalent communication style, and clinical decision-making by the supervisor that is not explicit. Residents applied instrumental, appraisal-focused, and emotion-focused coping strategies. Their suggestions for improvement included instructional design of the workplace-based curriculum, supervision, teaching content, and contextual factors. Conclusions: Within postgraduate training, addressing the organizational and contextual factors of entrustment and resident supervision is essential. Default entrustment decisions need to be explored and explicitly addressed to prevent overentrustment, meet residents’ need for supervision, and effectively coach residents to maintain their well-being.

Background: The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model. Methods: A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable. Results: Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services. Discussion: Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Background: Research concerning transitions from one rotation to another during medical specialist training is scarce. This study examined trainee doctors' perceived preparedness for core clinical activities, trainee doctors' preparedness levels, and general perceptions of medical specialist training in geriatric psychiatry.Method: Swiss trainee doctors in geriatric psychiatry were surveyed about their perceived preparedness for 18 preliminary entrustable professional activities (EPAs), curricular support, and general perceptions of their medical specialist training. Closed questions were analysed using descriptive statistics, while open questions were subjected to content analysis.Results: The participants comprised 48 trainee doctors (30.4% response rate) who differed in their educational experience (years of residency and specialism) and clinical subspecialisation goals. Trainee doctors felt adequately prepared for most EPAs but less prepared for some, including electroconvulsive therapy, psychotherapy, and treating older adults in the home environment or residential facilities. Despite the trainee doctors' diversity, they did not differ significantly in perceived preparedness for most EPAs. The most often offered suggestions for improving geriatric psychiatry training were intensified clinical supervision and a structured induction programme.Conclusion: Trainee doctors reported that they felt sufficiently prepared for most EPAs, regardless of their backgrounds and professional goals. However, several professional activities in geriatric psychiatry warrant further training. Our findings indicate the need for a higher intensity of clinical supervision (e.g. more direct observation and specific feedback), the introduction of structured induction programmes (e.g. orientation week), and specific teachings (e.g. on neurocognitive assessment).