What good healthcare looks like when there is no neat diagnosis
The blood tests are normal. The scan shows nothing concerning. The specialist has ruled out the obvious possibilities. From a medical perspective, this is reassuring news. Yet the patient sitting in front of you is still exhausted, dizzy, in pain or struggling to concentrate. They may no longer be working normally, exercising, sleeping well or managing ordinary daily activities. They have been investigated, perhaps extensively, but the problem that brought them into healthcare has not disappeared.
This is one of the more difficult spaces in healthcare because medicine is built, understandably, around finding answers. Symptoms lead to investigations, investigations lead to diagnoses and diagnoses lead to treatment. But real patients do not always follow that sequence.
Sometimes the tests are reassuring and the patient is still not well.
The challenge then becomes a different one. How do we continue providing good healthcare when we do not yet have a satisfying explanation?
When reassurance stops feeling reassuring
A normal investigation is valuable. It may exclude a serious disease, reduce the likelihood of another or indicate that further testing is unnecessary. But there comes a point when repeatedly telling someone that their results are reassuring may stop feeling reassuring to the person receiving the message.
Imagine being told for the fourth or fifth time that everything looks normal while you are still unable to get through a normal working day.
The practitioner may be saying, “We haven’t found evidence of something dangerous.” The patient may hear, “There is nothing wrong with you.”
That gap matters because it can change the entire relationship between the patient and healthcare. Some patients begin searching harder for an explanation, moving between practitioners, requesting additional investigations or turning to the internet and AI in the hope that someone or something will finally make sense of their symptoms. Others begin to disengage from healthcare altogether because they no longer expect to be believed.
Recent research has increasingly recognised the problem of diagnostic uncertainty and the way it is communicated. A 2026 paper on diagnostic doubt argues that uncertainty needs to be made more visible within healthcare rather than hidden behind premature certainty. When patients experience significant symptoms but investigations do not provide a clear explanation, acknowledging what is known, what remains uncertain and what happens next may be more useful than simply repeating that the results are normal.
There is an important balance here. Persistent symptoms should not automatically trigger an endless series of investigations. More testing can create cost, anxiety and incidental findings that lead to still more testing. At the same time, a previous normal investigation should not become a reason to ignore new, changing or worsening symptoms.
Good care sits somewhere between those two extremes.
The uncomfortable leap from “unexplained” to “psychological”
One of the most sensitive moments in this journey occurs when physical investigations fail to provide an explanation and the conversation turns towards stress, anxiety, depression or other psychological factors.
Psychological factors absolutely can influence physical symptoms. Stress can affect sleep, pain, gastrointestinal function, muscle tension, fatigue and the autonomic nervous system. Anxiety can amplify bodily sensations and fear can change movement and behaviour. Living with persistent symptoms can itself produce anxiety, low mood and considerable emotional distress.
The problem is using psychology as the explanation simply because another explanation has not been found.
There is an enormous difference between saying, “There may be several biological, psychological and social factors contributing to what you are experiencing” and saying, “Your tests are normal, so this must be psychological.”
Contemporary thinking around persistent physical symptoms increasingly challenges this either-or approach. Symptoms can arise from complicated interactions between previous illness or injury, the nervous system, sleep, stress, behaviour, expectations, physical conditioning, psychological wellbeing and other biological processes. A recognised disease may be present, partially explanatory or entirely absent.
That complexity should make practitioners more curious, not less.
It also means psychologists and other health practitioners should never be positioned as the place patients are sent when medicine has “found nothing”. Psychological care can be enormously valuable in persistent illness, but it should form part of healthcare rather than function as evidence that physical symptoms were never legitimate.
Care does not have to wait for certainty
Perhaps the most important shift is recognising that diagnosis and care do not always have to happen sequentially.
A patient can spend months waiting for the next appointment, scan, blood test or specialist opinion while their world becomes progressively smaller. They stop exercising because activity feels unsafe. They sleep badly. Their strength declines. They withdraw from work or social activities. Anxiety increases because nobody can explain what is happening. By the time a diagnosis is eventually made, the original medical problem may no longer be the only problem that needs treatment.
This is where health practitioners can make a significant difference.
Rather than focusing exclusively on “What is causing this symptom?”, we can also ask “What is this symptom preventing you from doing?”
That question changes the consultation.
Pain can be considered in terms of movement and sleep. Fatigue can be considered in relation to daily routines, activity, nutrition and energy demands. Dizziness can be explored in terms of mobility, confidence and safety. Cognitive complaints can be considered in relation to work, stress, sleep and daily functioning. Anxiety about symptoms can be addressed without implying that anxiety caused the symptoms in the first place.
A physiotherapist may help rebuild strength, movement and confidence. An occupational therapist may help a patient adapt activities, conserve energy or return to meaningful roles. A psychologist may address fear, adjustment, anxiety or the emotional burden of prolonged illness. A dietitian may identify nutritional issues that are contributing to symptoms or recovery. Other health practitioners may address specific functional difficulties according to the patient’s needs.
In my case the the aim is to remove uncertaintly, not just to construct a treatment programme simply because medicine has run out of tests.
Measure the life, not only the symptom
Healthcare is very good at measuring things. We have pain scales, blood results, imaging findings, blood pressure readings and physiological measurements. They are essential, but they do not always tell us whether someone’s life is improving.
For patients living with persistent symptoms, function can become an important clinical measure in its own right.
Can the person walk further than they could a month ago? Are they sleeping better? Can they work for longer without becoming exhausted? Have they returned to driving, cooking, exercising or caring for children? Are they becoming more confident about movement? Are they participating in life again?
These are not consolation prizes just because a clear diagnosis hasn’t been found. They’re meaningful health outcomes. They also give both patient and practitioner a sense of progress.
What should health practitioners do differently?
The first step may be surprisingly simple: stop treating uncertainty as the end of the consultation.
Explain what the investigations have actually shown and what they have ruled out rather than simply saying everything is normal. Be clear about what remains uncertain. Ask what the symptoms are preventing the patient from doing and identify the areas of function that can be addressed now.
Just as importantly, provide a safety net. Patients should know which new or worsening symptoms require reassessment and when they should return rather than being left to decide whether a change is important enough to justify another consultation.
Where several practitioners are involved, communication becomes particularly important. A patient who hears one explanation from their doctor, another from their physiotherapist and a completely different interpretation from someone else in the healthcare team can become more confused rather than reassured. Shared goals and consistent explanations can reduce that uncertainty.
And perhaps we need to become more comfortable saying something that healthcare professionals are often reluctant to say:
“I don’t yet know exactly why this is happening, but there are still things we can do to help.”
That is not an admission of failure. It may be one of the most accurate and useful things a practitioner can say.
When the answer hans’t arrived yet
There will always be conditions that are difficult to diagnose. Some patients will eventually receive an explanation after months or years of uncertainty. Others may never receive a single diagnosis that accounts for everything they experience.
The responsibility of healthcare is not to pretend that every symptom has an immediate explanation. Nor is it to investigate indefinitely in pursuit of certainty that may never come.
It is to remain clinically alert, communicate uncertainty honestly and continue addressing the parts of health and function that can be improved.
Sometimes the most important question in the consultation is not “What diagnosis have we missed?”
It is “What does this person need from us while we are still working it out?”
Because “we cannot find the cause yet” should never quietly become “there is nothing more we can do.”
Research behind this article
Löwe B, Toussaint A, Rosmalen JGM et al. Persistent physical symptoms: definition, genesis and management. The Lancet, 2024.
Chel M, Rajput-Ray M, Jani K et al. Make diagnostic doubt visible in healthcare. Future Healthcare Journal, 2026.
Medically Unexplained Symptoms: A Systematic Umbrella Review of Current Terminology and Reported Rationales, 2026.