Understanding the language around medically unexplained and overlooked conditions can be difficult. Here's a guide to some of the key terms we use:

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Forgotten Patient:

A person known to healthcare professionals with ongoing medical issues, whose problems are not actively being addressed — often falling through the cracks in the healthcare system.

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Overlooked Diseases:

​Diseases or conditions for which there is little professional interest in prevention, diagnosis, treatment, or cure — despite a clear underlying pathological process.

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Medically Unexplained Symptoms (MUS):

Symptoms for which no identifiable disease is found after appropriate investigation.
This does not mean the symptoms aren’t real or that no physical process is involved — only that a clear medical cause hasn’t been discovered yet.

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🔸 Why the term is controversial:
MUS is falling out of favour because:

• It doesn’t capture complexity (e.g. severity, duration, underlying mechanisms)

• It’s often misinterpreted to mean symptoms are "all in the mind"

• Within psychiatry, it has been linked to psychological causes — which may apply in some cases, but not all

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Many clinicians now prefer alternative terms, especially when symptoms are persistent or complex.

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Persistent Physical Services (PPS):

A more widely used umbrella term for distressing physical symptoms — such as pain, fatigue, or breathlessness — that last for several months or more, regardless of the cause.

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Symptom Based Disorders:

Symptom based disorders' is a relatively new term to encompass a range of symptoms rather than biomedical tests. These disorders include fibromyalgia and irritable bowel syndrome, and functional neurological disorders. These present with persistent, distressing symptoms that tend to cluster and are not well and are not well explained or treated by the dominant medical model.

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Persistent Somatic Symptoms (PSS):

Often used interchangeably with PPS.
“Somatic” means “of the body,” but some patients find this term off-putting, as it can imply a mind–body split, or that the symptoms are not real.

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Somatic Symptoms Disorder (PSD):

A diagnosed condition in which a person’s thoughts, feelings, or behaviours related to their symptoms become excessive or disproportionate — regardless of whether a medical cause is found.

📌 This is not faking or exaggerating.
The person is genuinely suffering and believes they are unwell.
SSD is linked with serious distress, disability, and healthcare burden.

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Unbearable Unexplained Symptoms (UUS):

A term coined by Dutch researchers (Witte Raven, van Leeuwen et al. 2019) to describe the emotional impact on doctors when faced with a patient who:

• Reports serious symptoms

• Has no clear diagnosis

• Triggers concern that something important is being missed

“It just can’t be true that there’s nothing wrong… What am I overlooking?”
UUC reflects the first stage of a diagnostic journey — one that may lead to discovery, or at least a more targeted referral.

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Causes of Persistent Physical Symptoms

These symptoms may arise from:

• Infections

• Injuries

• Medical diseases

• Stressful life events

• Or appear spontaneously (de novo)

Over time, clear medical explanations may become harder to find. A range of biological and psychological factors can contribute, including:

• Persistent inflammation

• Microbiome or immune dysfunction

• Epigenetic influences

• Depression or anxiety

• Symptom-focused behaviours and avoidance

• Early trauma

• Learned responses and expectations

These factors often overlap across conditions and require a broad, holistic approach to care.