Medical Gaslighting in Urban Healthcare: A Bioecological Framework for Health Equity and Participatory System Transformation

Medical gaslighting describes patient experiences in which symptoms, concerns, or interpretations of illness are minimized, dismissed, or insufficiently recognized within healthcare encounters. While the term initially emerged from patient and community narratives, recent empirical and conceptual studies (2019–2024) have further documented patterns of diagnostic overshadowing, credibility deficits, and structural contributors to patient invalidation. These findings indicate that interpersonal dismissal often reflects broader organizational and systemic dynamics. This paper proposes a bioecological framework for understanding medical gaslighting as a multi-level phenomenon within urban healthcare. Drawing on Bronfenbrenner’s bio-ecological theory, Fricker’s concept of epistemic injustice, Lipsky’s theory of street-level bureaucracy, and participatory traditions advanced by Dewey, Freire, and community-based participatory research, the framework examines how experiences of invalidation arise through interactions among patients, clinicians, healthcare organizations, policies, and communities. Participatory approaches position patients and communities as partners in defining problems, generating knowledge, and designing solutions. This framework conceptually advances participatory knowledge production as a mechanism for organizational learning and system transformation. Addressing medical gaslighting requires more than improving communication; it requires recognizing lived experience as legitimate knowledge and redesigning healthcare systems to support partnership, continuity, and learning from the patients and communities they serve. Because this model has not yet been empirically validated, its components should be interpreted as theoretical propositions intended to guide future research. By connecting individual experiences to system-level transformation, healthcare organizations can strengthen equity, trust and human-centered care.