UK Article June 2025: Doctors said I had ‘medically unexplained symptoms’. I have to treat myself

[Sly Saint]

Linda Webb was in her mid-40s when she started experiencing abdominal discomfort. Over time, the pain became excruciating. She visited A&E and her GP multiple times for help, was admitted to hospital, as well as subject to a battery of testing, which could not explain her symptoms. After a year of back-and-forth, she required daily doses of oramorph, a liquid form of morphine, just to control her pain. “It was then my GP decided I was suffering from depression,” says Webb, a property consultant from Yateley in Hampshire. On medical notes, it was referenced that she was experiencing “medically unexplained symptoms” (MUS) – under NHS guidelines, if a diagnosis does not become clear after routine tests, then support through mental health services is suggested. But for some patients, like Webb, this just feels like the system giving up.

MUS: A common diagnosis
The ‘MUS’ diagnosis is now very common across all forms of NHS healthcare, accounting for 45 per cent of all GP visits and 20 per cent of all new consultations with specialists. Along with changes to NHS treatment guidelines just over a decade ago – suggesting that mental healthcare support should be offered to anyone found to have MUS – many doctors treat unexplained pain or other symptoms as if it is an expression of health anxiety. Unsurprisingly, patients with MUS account for 20 to 25 per cent of all frequent attenders to medical clinics. One GP working in South London said MUS was now a normal part of general practice, saying: “We exclude important diagnoses but sometimes we can’t always explain the symptoms.” But she added: “MUS seems to be a new word for ‘somatising symptoms’”. Somatic symptom disorder is when a person focuses on physical symptoms, such as weakness or shortage of breath, to the extent that it leads to psychological distress. In other words, another term for health anxiety. For many MUS patients, that may well be the case, but for others such as Webb, this process of channelling complex patients through mental health treatment in lieu of other treatments may lead to missed or mis-diagnosis. Worse, once MUS is on your medical file, patients and experts say it can potentially affect how future care is handled by the NHS.

MUS can be used in a derogatory way
Dr Dean Eggitt, a GP based in Doncaster, thinks that’s very possible. He believes diagnosis by algorithm is becoming a huge issue for the NHS. “When a patient doesn’t fit into this nice category, and you’ve explored several different types of categories, [MUS] can be used in a derogatory way. This patient is complaining about something, and we haven’t found a diagnosis, so it can be seen as if they’re making it up,” he says. Certain conditions that come under the umbrella of MUS, such as chronic fatigue syndrome, certainly affect the diagnostic process. “Once that condition is labelled on that patient record, and they come in and have something that doesn’t fit in another category, then you say it’s that. That also means that when a patient has that label, they’re likely also to have further medically unexplained symptoms. That’s the sad reality.”

'Somatising patients' were costing the NHS©The i Paper
In 2010, a paper presented to the health secretary Jeremy Hunt said “somatising patients” were costing the NHS £3bn a year and sought to find cheaper ways to deal with their distress than regular medical testing. When the IAPTS (Improving Access to Psychological Therapies) programme was first established as a better way to treat mental health issues in the NHS, giving patients more power to self-refer, part of the economic justification was that it could be paid for by savings from physical healthcare. Dr Eggitt does believe using mental health routes as a treatment is a useful approach, not a fob off – because suffering from unexplained pain or other distressing symptoms is enough to affect someone’s mental health. But in the current environment of an overstretched NHS, he admits, mistakes are made and for patients, it can feel like a dismissive approach.

MSN

 

[V.R.T.]

This insane approach has dogged my entire adult life. Like has anyone stopped and thought how insane it is to claim that 40% of people seeking medical care are somatising? It's bonkers, it makes no sense. And telling people who are having extremely distressing symptoms that they are just normal symptoms their brain is misinterpreting is fucking traumatic. It caused me to push through horrific neurological symptoms instead of avoiding triggers, for example I continued to try to smoke cannabis in my late teens/twenties when it was having really bad allergy(?) and psychiatric effects on me because I thought I was just somatasing and if I kept smoking it I could get back to being someone who could tolerate it.

Even if panic attacks are psychogenic which tbh I doubt in a lot of cases, it doesn't follow that it is your body misinterpreting normal sensations and that is the cause of distress. It's just another way to blame the sufferer. 'Get on your bike' with a big caring smile.

And that was before I even got PEM. At which point this approach was deployed again and destroyed me. There must be a moral reckoning for this penny pinching gaslighting bullshit. There probably won't be, but there must.

 

[Hoopoe]

My father is a doctor and he abandoned me because of psychosomatic theories that claimed my symptoms would get worse if they were taken seriously and attention paid to them, whereas deliberate indifference would help me get better.

Anyone who is sick is desperate for help and this is easily confused with "subconsciously feigning symptoms to gain attention". It's a problem we can't solve on our own so we look for others to help. That doesn't mean I'm fabricating symptoms to gain something from others. It's just normal behaviour, but for some reason the psychosomatic proponents interpret it badly.

When will these insane ideologies be questioned and the harm exposed?

I was also harmed in another way by the idea of psychosomatic symptoms. I was still a child and actually believed that my symptoms were due to a character flaw. I went to therapy and came out of it believing that I'm a weak, flawed person that needed to make a good effort to become better person and that meant pushing through my symptoms as much as possible. No one here will be surprised to hear that this led to a continuous downward spiral that ended in a catastrophe (persistently worse illness, destroyed family relationships, total social isolation, suicidal depression). This could all have gone completely different had there been somehow who said this is an illness, it's not your fault and there is no hidden meaning or psychological cause that you must discover, you just need to learn how to live with it and you'll need some support because you won't be able to perform as well as before and need not blame yourself for it.

 

[V.R.T.]

My father is a doctor and he abandoned me because of psychosomatic theories that claimed my symptoms would get worse if they were taken seriously and attention paid to them, whereas deliberate indifference would help me get better.

Anyone who is sick is desperate for help and this is easily confused with "subconsciously feigning symptoms to gain attention".

When will these insane ideologies be questioned and the harm exposed?

I was also harmed in another way by the idea of psychosomatic symptoms. I was still a child and actually believed that my symptoms were due to a character flaw. I told myself that I'm a weak, flawed person that needed to make a good effort to become better person and that meant pushing through my symptoms as much as possible. No one here will be surprised to hear that this lead to a continuous downward spiral that ended in destroyed family relationships, total social isolation, suicidal depression and long lasting suffering. This could all have gone completely different had there been somehow who said this is an illness, it's not your fault and there is no hidden meaning or psychological cause that you must discover, you just need to learn how to live with it and you'll need some support.

I am so sorry this happened to you. I can't imagine how hard that must have been.

I know I bring it up a lot but I knew whatever was happening to me wasn't psychosomatic until my GP gaslighted me about it. He also basically refused to diagnose me, saying I 'didn't want' the label without explaining why. On reflection I think he clearly believed if he diagnosed me I would get worse. When doctors are told that the kindest thing is to withold diagnosis and push patients towards mental health/psychogenic explanations, it causes immeasurable harm.

I also could have written similar to what you did in terms of thinking my unexplained symptoms that appeared in my late teens were due to character flaws. It made me despise myself, drove me deeper and deeper into addiction and made me choose a life course where I was endlessly 'improving myself' which made everything worse. I did what my therapists and GPs told me and nothing got better and I felt like a failure. But they had failed me.

 

[Utsikt]

I’m so sorry that happened to you, @Hoopoe

On reflection I think he clearly believed if he diagnosed me I would get worse.

I’ve seen Norwegian educational videos targeted at HCs that claim this. It’s only «safe» to give an ME/CFS diagnosis if the patient believes that they can still recover despite the diagnosis.

It’s completely absurd.

 

[Cinders66]

One fun thing to do is to question the validity of your doubting relatives when they get illness or pain - so if your mum says oh I’ve hurt my arm or your dad says oh I’m going down with an infection you say oh I don’t think you are, I think your exaggerating, have you considered if it is your mind or mood and they don’t like it very much.

 

[V.R.T.]

It’s only «safe» to give an ME/CFS diagnosis if the patient believes that they can still recover despite the diagnosis.

This is so crazy. It's all so mad. Honestly madder than some of the antivax/wellness stuff.

Like this is demonstrably more insane than, for example, people thinking that a drug or supplement that has no effecacy helps them.

But cancer patients didn't use to be told out of fear they'd give up and succumb. It's so widespread, the idea that you fight illness with your willpower and are victorious over it. Susan Sontag's Illness and It's Metaphors is a really good exploration of this.

 

[Hoopoe]

Maybe it's up to us patients to create an alternative to the psychosomatic ideology. One where the relationship to the disability and symptoms is accepting and not minimizing/denialist. Where the advice given is practical advice on how to best life with the illness and manage symptoms, without reference to obscure hidden powers of the mind that we must believe in.

 

[Yann04]

I’ve seen Norwegian educational videos targeted at HCs that claim this. It’s only «safe» to give an ME/CFS diagnosis if the patient believes that they can still recover despite the diagnosis.

It’s completely absurd.

Late stage disciplinary gaslighting.

 

[Hutan]

Webb knew there was something else going on, but struggled to navigate help given that she was now an MUS patient. “At the time, I was a GP nurse myself, so had some knowledge of the medical system. I wasn’t happy with the diagnosis, but I got the impression that if I didn’t try the antidepressants, my GP wasn’t going to be prepared to help me any further as I wasn’t ‘helping myself. In the end, feeling I had nothing to lose, I started them.” A few days later, a long-awaited gynaecological appointment came around. The specialist suggested more tests, with the chance of a hysterectomy to see if it helped manage the pain. “[The specialist] told me to stop the antidepressants immediately as they clearly weren’t needed,” Webb, now 59, says. “Several months later I had the surgery and the pain disappeared immediately; 18 months after it all started, I was unexplained diagnosed with adenomyosis.”

"Adenomyosis is a term generally reserved for endometriosis like deposits found within the wall of the uterus, similar 'lesions' can be found in other places."

So, this woman had a physical condition. Getting a label of MUS made it harder for her to get help, but she was a nurse, so she had a few clues and contacts. Eventually, a gynaecologist found the problem, operated, and she no longer had the pain.

The ‘MUS’ diagnosis is now very common across all forms of NHS healthcare, accounting for 45 per cent of all GP visits and 20 per cent of all new consultations with specialists.

That is utterly ridiculous. I don't know where the writer of the article got the information from - if they misunderstood something, or if the source got it wrong.

Factors associated with the consultation of GPs among adults aged ≥16 years: an analysis of data from the Health Survey for England 2019

Regarding reasons for GP consultations, 83.5% were for physical health problems, 5.1% for mental health problems, and 11.5% for a combination of physical and mental health problems

 

[Hutan]

I suppose it's not entirely clear if a MUS diagnosis might account for a 'physical health problem'. I mean, I don't think so, but just to be sure, here's some data from the Royal Australian College of GPs - Paul Glasziou no less.
Common general practice presentations and publication frequency


Top 30 problem types for GP consultations (note the list is in two columns - 1 to 15 and then 16 to 30)

Rank	Problem type	Percent of problems (n=305 738)	Rate per 100 encounters (n=194 100)	Rank	Problem type	Percent of problems (n=305 738)	Rate per 100 encounters (n=194 100)
1	Hypertension	5.7	9.0	16	Test results	1.2	1.8
2	Immunisation/ vaccination: all	4.2	6.7	17	Urinary tract infection	1.1	1.8
3	Acute upper respiratory tract infection	3.3	5.1	18	Dermatitis, contact/allergic	1.0	1.6
4	Depression	2.9	4.6	19	Pregnancy	1.0	1.5
5	Diabetes: non-gestational	2.3	3.7	20	Sleep disturbance	1.0	1.5
6	Lipid disorders	2.1	3.4	21	Sinusitis acute/chronic	0.9	1.4
7	General check-up	1.9	3.0	22	Gastroenteritis	0.8	1.3
8	Osteoarthritis	1.7	2.7	23	Vitamin/nutritional deficiency	0.8	1.3
9	Back complaint	1.7	2.6	24	Malignant neoplasm of skin	0.8	1.3
10	Prescription	1.6	2.5	25	Abnormal test results	0.8	1.2
11	Oesophagus disease	1.6	2.4	26	Atrial fibrillation/flutter	0.8	1.2
12	Female genital check-up	1.5	2.4	27	Oral contraception	0.8	1.2
13	Acute bronchitis/ bronchiolitis	1.5	2.3	28	Solar keratosis/sunburn	0.8	1.2
14	Asthma	1.3	2.1	29	Ischaemic heart disease	0.7	1.1
15	Anxiety	1.2	2.0	30	Viral disease, not otherwise specified	0.7	1.1

able 2. The 30 most frequently managed problem​

MUS isn't in the top 30 problems. And the 30th most common problem (viral disease not otherwise specified) only accounts for 1.1 visits per 100.

 

[SNT Gatchaman]

Adenomyosis (and endometriosis) are common. Figure from the 2022 consensus guidelines for typical ultrasonographic appearance —



Consensus on revised definitions of Morphological Uterus Sonographic Assessment MUSA features of adenomyosis: results of modified Delphi procedure
M. J. Harmsen; T. Van den Bosch; R. A. de Leeuw; M. Dueholm; C. Exacoustos; L. Valentin; W. J. K. Hehenkamp; F. Groenman; C. De Bruyn; C. Rasmussen; L. Lazzeri; L. Jokubkiene; D. Jurkovic; J. Naftalin; T. Tellum; T. Bourne; D. Timmerman; J. A. F. Huirne

Spoiler: Abstract

OBJECTIVES
To evaluate whether the Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis need to be better defined and, if deemed necessary, to reach consensus on the updated definitions.

METHODS
A modified Delphi procedure was performed among European gynecologists with expertise in ultrasound diagnosis of adenomyosis. To identify MUSA features that might need revision, 15 two-dimensional (2D) video recordings (four recordings also included three-dimensional (3D) still images) of transvaginal ultrasound (TVS) examinations of the uterus were presented in the first Delphi round (online questionnaire). Experts were asked to confirm or refute the presence of each of the nine MUSA features of adenomyosis (described in the original MUSA consensus statement) in each of the 15 videoclips and to provide comments. In the second Delphi round (online questionnaire), the results of the first round and suggestions for revision of MUSA features were shared with the experts before they were asked to assess a new set of 2D and 3D still images of TVS examinations and to provide feedback on the proposed revisions. A third Delphi round (virtual group meeting) was conducted to discuss and reach final consensus on revised definitions of MUSA features. Consensus was predefined as at least 66.7% agreement between experts.

RESULTS
Of 18 invited experts, 16 agreed to participate in the Delphi procedure. Eleven experts completed and four experts partly finished the first round. The experts identified a need for more detailed definitions of some MUSA features. They recommended use of 3D ultrasound to optimize visualization of the junctional zone. Fifteen experts participated in the second round and reached consensus on the presence or absence of ultrasound features of adenomyosis in most of the still images. Consensus was reached for all revised definitions except those for subendometrial lines and buds and interrupted junctional zone. Thirteen experts joined the online meeting, in which they discussed and agreed on final revisions of the MUSA definitions. There was consensus on the need to distinguish between direct features of adenomyosis, i.e. features indicating presence of ectopic endometrial tissue in the myometrium, and indirect features, i.e. features reflecting changes in the myometrium secondary to presence of endometrial tissue in the myometrium. Myometrial cysts, hyperechogenic islands and echogenic subendometrial lines and buds were classified unanimously as direct features of adenomyosis. Globular uterus, asymmetrical myometrial thickening, fan-shaped shadowing, translesional vascularity, irregular junctional zone and interrupted junctional zone were classified as indirect features of adenomyosis.

CONCLUSION
Consensus between gynecologists with expertise in ultrasound diagnosis of adenomyosis was achieved regarding revised definitions of the MUSA features of adenomyosis and on the classification of MUSA features as direct or indirect signs of adenomyosis.

Link | PDF | Ultrasound in Obstetrics & Gynecology [Open Access]

 

[Sean]

The whole psychosomatic project is the greatest and cruelest catastrophe in modern medicine. Hands down winner. Not even close to second place.

The degree, ubiquity, and sheer persistence of technical and ethical failure at all levels of governance required for this to situation to come about is staggering. How such appalling drivel has been allowed to become so entrenched, powerful, and immune to accountability defies belief.

But here we are. It has, and it continues to metastasise almost unchecked throughout the profession and broader society.