Synopsis
Assess persistent physical symptoms respectfully, recognise positive functional diagnoses where appropriate and coordinate care that reduces disability and unnecessary harm while remaining alert to new disease.
- Unexplained symptoms are real experiences; the absence of a structural explanation does not establish fabrication.
- The phrase medically unexplained is a provisional description and should give way to a specific supported diagnosis when one can be made.
- Functional neurological disorder is diagnosed from positive clinical features interpreted by appropriate expertise, not merely a normal scan.
- Physical disease, functional symptoms, depression and anxiety can coexist; none automatically excludes the others.
- Review what previous tests actually assessed and explain the uncertainty and limits without repeating investigations reflexively.
- Agree goals around function, symptom management and a consistent plan, involving relevant rehabilitation and psychological services.
- Reassess new symptoms or signs on their own merits and provide explicit safety-netting.
Key red flags
New focal neurological deficits, altered consciousness, significant bleeding, fever, weight loss or unstable observations require an ordinary medical assessment regardless of earlier normal tests.
Repeated admissions with escalating procedures, opioids or conflicting explanations may themselves be causing harm and should prompt coordinated senior review.
Investigation priorities
Identify the current syndrome, functional impact and any features needing urgent medical investigation.
Management branches
Assessment has not identified the initially suspected disease or supports a functional symptom disorder.
- Acknowledge the symptom and its impact, ask what explanation the patient has been given and clarify their main concern.
- Explain the positive findings and the limits of completed tests, distinguishing a supported diagnosis from remaining uncertainty.
- Agree a written account and plan with the relevant specialty so that subsequent clinicians provide a consistent, clinically grounded explanation.