Opinion The challenge of persistent physical symptoms 2025 Tookman et al

Andy

Andy

Senior Member (Voting rights)

Background​

Persistent physical symptoms (PPS) for which no medical explanation has been found are challenging for patients, families, and their doctors. A multidisciplinary conference,<a href="https://bjgp.org/content/75/761/579#ref-1">1</a> and a subsequent article in a national UK newspaper, highlighted the long and painful health journey of a patient with complicated symptoms called Maureen who was searching for a diagnosis.<a href="https://bjgp.org/content/75/761/579#ref-2">2</a> The wave of correspondence that followed from others detailed longstanding unresolved health issues that were characteristically sad and diverse, united by a sense of frustration and hopelessness.

Box 1.

Key messages​

  • Persistent physical symptoms (PPS) are common, complex, and carry significant personal and societal burdens that are underrecognised.
  • Patients often face repeated tests and referrals, delays, disbelief, and a lack of empathy. A diagnosis, while it may not lead to a cure, can offer relief and hope.
  • For doctors, managing PPS is challenging because of frequent attendances, time constraints, limited resources, siloed care, and a shortage of general physicians.
  • Greater awareness, research, and resources are needed. Patients benefit from unhurried consultations, continuity, early genetic testing, and an empathic approach aided by diagnostic tools, management algorithms, multidisciplinary teams, and availability of specialist clinics.
  • When diagnosis is elusive or symptoms persist, GPs’ support, coordination, and whole-person approach are key.
In most advanced health systems, common medical issues such as cancer, heart disease, and stroke are subject to evidence-based guidelines and fast-track treatments. These initiatives are supported by specialists, dedicated funding, and research. By comparison, people like Maureen are poorly served; it could be argued that their management represents a major public health issue yet to be addressed. While the topic generates increased discussion, resources remain unavailable to most patients beyond a few specialist centres. Is this because the issue is too big, diverse, and complicated to be a recognised entity? Perhaps there is a sense of futility among healthcare professionals (HCPs) and governments that patients with complex PPS will always be with us and a dedicated strategy would be too expensive? While traditional medical skills and available treatment can do much, we argue that an integrated and appropriately funded national approach will prove economically beneficial and help many.

Open access
 
First author is Dr Adrian Tookman – Palliative Medicine Physician (retired), Lead Field Editor Cochrane PaPaS review group, former Medical Director NHS Foundation Trust, London, UK, who is also chair of registered UK charity, Forgotten Patients: Overlooked Diseases, who say

"The Problem

Modern healthcare can achieve incredible things — but some people with undiagnosed or complex symptoms are forgotten in the system and miss out on vital interventions. Even patients with recognised conditions can be overlooked.

While there are charities for specific rare diseases, those who are misdiagnosed or fall between categories often have little support.
We want to change that.


Who we are

We are a multidisciplinary, international group of:

Healthcare professionals

Scientists and researchers

Public health experts

People with lived experience

Ethicists, chaplains, and spiritual carers

Campaigners, communicators, and politicians


We are united by one aim: to advocate for those overlooked in healthcare."
 
I wish I could believe them, but everything that starts this way ends up fuelling the problem by approaching it the same old way while pretending it's all brand new and compassionate, which is the same old way.

It always seems to just avoid the elephant in the room: there is work left to do, medical science is very far from over. It's in the subtext but it's treated as a minor issue, one that can be corrected with proper multidisciplinary good intentions, which guarantees failure because it's the same old way that has led to here and now.

In the end it's always agendas, and those agendas never actually have anything to do with us. It's always about them in the end. I wish this is different, but it almost never is.
 
Andy said:
Patients benefit from unhurried consultations, continuity, early genetic testing, and an empathic approach aided by diagnostic tools, management algorithms, multidisciplinary teams, and availability of specialist clinics.
Click to expand...
Sounds like the usual waffle to justify the usual waffle and wasting a lot of money on the usual waffle. We need better than this.
 
Why do you never see any of them arguing for access to basic healthcare? Being offered routine screenings and GP appointments at home when needed.

Nobody's going to do genetic screening in the real world—for a start, they'd have no idea what they were screening for—and algorithms and diagnostic tools won't butter any parsnips. If they're so keen on these multidisciplinary teams, where the chuff are they? How do you get an appointment with them? Do they come to the house if you're severely ill?
 
These articles tend to acknowledge that the system is not working well and then propose to continue along the same path which led to the dysfunction.

If the disease is not understood you can't propose frameworks that are based on an illusion or pretense of understanding. These frameworks are one reason of the dysfunction.

And "somatic symptom disorder" is just a different way of saying "we don't believe you are a credible witness to your illness". With doctors being taught to use diagnoses like this, is it any surprise that patients encounter disbelief and negative attitudes? Get rid of these diagnoses and things will improve.
 
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