Medically unexplained symptoms: how often and why are they missed?

We assessed risk factors affecting the provisional diagnosis of medically u nexplained symptoms made by physicians in new patients, in 526 clinical enc ounters. Comparisons were made between the doctor's initial assessments reg arding the nature of symptoms, and the final diagnosis. Physicians were mor e likely to err on the side of diagnosing the symptoms as medically explain ed rather than unexplained. When physicians perceived the interaction with the patient to be positive, they were more likely to make a provisional dia gnosis that the symptoms were explained. Conversely, a negative perception of the interaction was associated with an increased likelihood of viewing s ymptoms as medically unexplained. Physicians should be aware of the effect of their own perceptions on their diagnostic behaviour.