yes we often have patients with a collection of symptoms that don’t make sense or fit a particular condition. It is difficult as patients tend to like a diagnostic label, doctors too really as it helps give patients a prognosis (ie what’s going to happen to them due to the condition).
These patients tend to get lots of tests done, but at some point you have to say stop (as tests can cause harm occasionally) and go with your best guess.
As ever communication is key, agree a plan with your patient and review it, aim for symptom control on the basis its not likely to be terminal illness more a long-term condition.
Good question. Actually it happens quite a lot in general practice. If I’m not able to make a specific diagnosis I explain my thought processes to the patient and try to rule out serious conditions that need immediate action (things like heart attacks, blood clots in the legs or lungs and cancer). Sometimes we’ll agreed to try a treatment to see if they respond. Other times we might agree a watch and wait strategy as many minor conditions get better on their own. It might be appropriate to arrange more tests or refer to a specialist. Sometimes we accept there is not an obvious diagnosis and focus on managing symptoms.