Forgotten Patients: Overlooked Diseases
PUBLICATIONS
The Challenge of Persistent Physical Symptoms
BJGP Life, September 2025
AUTHORS
Adrian Tookman, Jay Verna, Eva Diehl-Wiesenecker, Richard Stephens, Jennifer McCallum, Ursula Unterberger and Steven Walker
An emotional and clinical journey representative of a person with persistent physical symptoms. MDT = multidisciplinary team.
ABOUT
Persistent physical symptoms (PPS) without a clear medical explanation are common and challenging for patients, families, and healthcare professionals. Individuals may experience ongoing pain, fatigue, neurological or multisystem symptoms that do not align with established diagnostic pathways, often leading to repeated consultations, inconclusive tests, and prolonged uncertainty.
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Despite their prevalence, PPS are frequently under-recognised. Patients may feel lost within the health system, encounter disbelief, and experience deterioration in physical and mental wellbeing. Clinicians face their own challenges, including limited time, fragmented services, and diagnostic uncertainty.
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This article explores the complexity of PPS and the consequences of delayed or absent diagnosis. It highlights the need for greater awareness, continuity of care, multidisciplinary approaches, and improved systems to ensure patients with persistent symptoms are believed, supported, and not forgotten.
Medically unexplained symptoms: four perspectives
BJGP Life, March 4, 2024
AUTHORS
Christianne Forrest, Minha Rajput Ray, Peter Speck, Adrian Tookman, Steven Walker
Featured photo by Eduardo Sánchez on Unsplash.
ABOUT
Managing individuals with persistent symptoms but no clear diagnosis is a common and challenging problem in primary care. Here, the term medically unexplained symptoms (MUS) is frequently used. MUS generally refer to persisting physical complaints for which clinical examination and investigations have so far failed to find a cause. Limited data suggest that people with MUS frequently experience a cycle of regular medical attendances, inconclusive tests, and unsuccessful, potentially harmful interventions. Unsurprisingly, management of such individuals comes with a high socioeconomic burden. People feel lost within the health system not knowing where to turn, and are at risk of deterioration and mental illness.
In this article, we offer four perspectives from patients and healthcare professionals (HCPs) with the aim of reminding ourselves of the challenges faced by some of those affected.
"The challenge of medically unexplained symptoms, overlooked diseases and forgotten patients"
BJGP Life, August 12, 2022
Image: Forgotten gloves by the kerb, by Andrew Papanikitas, 2022
AUTHORS
Bill Noble, Adrian Tookman, Carmen Schmechel, Richard Stephens, Christine Oesterling,Karim Jani, Revd Peter Speck, Eva Diehl-Wiesenecker, Katia Chrysostomou, Steven Walker
ABOUT
Primary care can do so much but not everyone benefits. Some patients with medically unexplained symptoms (MUS) suffer years of referrals and inconclusive tests. Others find themselves overlooked by health care services and feel forgotten. Their voices are unheard, they are unable to find a way forward through the system. Diagnosis may be delayed when the disease is unfamiliar to the doctor, or when the physician incorrectly presumes a functional or psychogenic cause while failing to recognise an underlying pathological process. People in this ‘no man’s land’ may receive inappropriate and even harmful treatment. They risk mental health problems after being repeatedly told pain is “caused by past trauma or by stress”, or that it is “all in their head”.