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What should I do when doctors can't find my problem?

William B. Salt II., MD
Gastroenterology

First, be sure you've consulted with the right doctors, and then consider that you may have medically unexplained symptoms (MUS).

Never hesitate to seek a second opinion about your symptoms, including consulting with one or more specialists. You need confidence that your evaluation has been thorough and that your diagnosis is correct.

Medically unexplained symptoms is a diagnosis, and nearly one of every two people consulting with primary care doctors suffers with symptoms that can't be explained by medical tests. According to Kurt Kroenke, M.D., of the Indiana School of Medicine and Regenstrief Institute, Inc., one of the world's leading authorities in the research and management of symptoms, medically unexplained symptoms can be classified into five general categories (The Primary Care Companion to the Journal of Clinical Psychiatry, 2005).

  1. Partially Explained by a medical Disorder - Symptoms don't respond to standard treatment and aren't proportionate to the medical severity of the disorder.
  2. Symptom Only Diagnosis - Symptoms are simply described as a diagnosis, without an attempt to propose a cause for them.
  3. Functional Somatic Syndrome - Nearly every specialty recognizes and diagnoses collections of medically unexplained symptoms falling in that area of expertise. One example in my specialty of gastroenterology is irritable bowel syndrome. Another example in the specialty of rheumatology is fibromyalgia syndrome.
  4. Primary Psychiatric Disorder - Doctors consider undiagnosed depression and/or anxiety to be at least associated with medically unexplained symptoms, if not the most common cause of them.
  5. Somatoform Disorder - These are psychiatric diagnoses where there is preoccupation with physical symptoms, including pain, the most common symptom experience.

Medically unexplained symptoms are a special interest of mine, because they leave sufferers — and their caregivers (physicians, psychologists, spiritual counselors, and alternative healers) — frustrated, fragmented, and confused.

A new book (Salt and Hudson), Still Hurting? FIND HEALTH! Discover What's Behind Your SYMPTOMS (That Doctors Can't Explain) proposes that a new model of disease is necessary in order to understand how and why medically unexplained symptoms occur and what people can do to help themselves and work effectively with their caring professionals.

 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.