Not “all in the mind”

Patients with persistent, severe, but medically unexplained physical symptoms baffle and frustrate doctors. Without a diagnosis they can’t be put on established disease pathways and it’s hard to know how best to manage them. Patients struggle with “unvalidated” illness and seek views from many different practitioners. Recently, a multidisciplinary group of clinicians and patients with an interest in “medically unexplained symptoms” (MUS) got together in London to shed light on a problem which deserves more attention than it gets.As I travelled to the meeting, I remembered a middle aged man we (junior doctors) repeatedly admitted to the medical wards complaining of excruciating pain for which no cause was ever found. Few of us believed his symptoms were genuine. Fortunately for him, the lead physician did, and ensured he was given strong analgesics. Over time, the consultant had become convinced he had a rare disorder called stiff person syndrome.1Given the rate…
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