What should we say to patients with symptoms unexplained by disease? The "number needed to offend"

Most doctors make a diagnosis and offer treatment to patients whose symptoms turn out to be unexplained by disease.(1) In such cases a diagnostic label is important in signifying to the patient and family that the doctor is taking the problem seriously and accepts the complaints as real. Some diagnostic labels, particularly those that sound "psychological," can be perceived by patients as offensive by implying that the patients are "putting on" or "imagining" their symptoms or that they are "mad."(2) Various potentially suitable diagnoses are available to doctors. "Hysteria" was the traditional term and is still sometimes used. "Functional nervous disorder" was used in the late 19th century to denote symptoms arising from disordered nervous functioning,(3) but in the 20th century this was superseded by terms that implied psychogenesis, such as psychosomatic.(4) In the past 20 years more neutral descriptive terms such as "medically unexplained symptoms" have gained in popularity.(1) Despite their importance in the doctor-patient relationship, the implications to patients of these labels have received remarkably little attention. We explored the differing connotations and potential offensiveness of 10 different medical labels for the symptom of weakness.