Background & Objectives: Psychosomatic disorders and persistent somatic symptoms are considered among the most challenging clinical areas in contemporary medicine, a domain in which the boundary between body and mind is constantly a site of contention, ambiguity, and reductionism. Psychosomatic patients frequently present with persistent physical symptoms that lack sufficient organic explanation, placing them at the intersection of medical and psychological care. Despite the high prevalence of such patients in clinical settings, the diagnosis and treatment of psychosomatic conditions remain challenging for healthcare systems. Previous research has predominantly focused on patients’ experiences, while the perspectives of medical staff—who function as the primary gatekeepers of diagnosis, referral, and treatment—have received comparatively limited attention. Understanding the challenges faced by medical professionals is essential for identifying systemic barriers and improving the quality of care for psychosomatic patients. Therefore, this qualitative study aimed to explore the challenges associated with the diagnosis and treatment of psychosomatic patients from the perspective of medical staff, with particular attention to structural, educational, emotional, and interprofessional factors within the healthcare system.

Methods: A qualitative research design was employed using in–depth, semi–structured interviews with members of the medical staff, including physicians from various specialties involved in the care of psychosomatic patients. Participants were selected through purposive sampling to ensure diversity in professional roles, clinical experience, and areas of specialization. Data collection continued until theoretical saturation was achieved. Interviews were audio–recorded, transcribed verbatim, and analyzed using an inductive coding process consistent with grounded qualitative analysis. Open, axial, and selective coding were conducted iteratively, allowing categories and their relationships to emerge from the data. Trustworthiness was ensured through prolonged engagement with the data, peer debriefing, and reflexive memo writing.

Results: Analysis of the interviews led to the identification of several interrelated categories that collectively illustrate a gradual erosion of the therapeutic alliance in the care of psychosomatic patients. One major category concerned the role of the healthcare system, characterized by delayed and non–systematic referral pathways, a lack of clear clinical algorithms for psychosomatic presentations, and a tendency toward prolonged biomedical interventions despite limited effectiveness. Participants reported that such structural shortcomings often left patients frustrated and mistrustful before meaningful psychological interventions were considered. A second category reflected clinical and communicative practices, including the use of non–specialized treatments, insufficient attention to medication side effects, and the inadvertent invalidation of patients’ lived experiences through reductionist or dismissive language. These practices were perceived by participants as contributing to patients’ loss of trust in medical care and resistance to further treatment. The third category highlighted the emotional dimensions of medical practice, particularly emotional exhaustion, feelings of clinical inefficacy, and defensive emotional distancing. Medical staff described repeated encounters with complex psychosomatic cases as emotionally demanding, often leading to burnout and a diminished capacity for empathy as a form of professional self–protection. Another salient category involved the gap between medical education and clinical reality. Participants emphasized that formal medical training often inadequately prepares clinicians to manage diagnostic uncertainty, emotional complexity, and mind–body interactions inherent in psychosomatic cases. As a result, physicians reported reliance on reductionist biomedical frameworks that fail to address the multifaceted nature of patients’ symptoms. Finally, the absence of institutionalized interprofessional collaboration emerged as a critical challenge. Participants described fragmented care, a lack of structured feedback following referrals, and insufficient shared language and trust among different medical and mental health disciplines. This lack of coordinated teamwork was perceived as reinforcing systemic inefficiencies and perpetuating suboptimal patient outcomes.

Conclusion: Based on the research findings, somatization is not merely an individualistic or biomedical phenomenon, but rather the outcome of a multi–level interplay between structural, relational, and emotional factors within the healthcare system. Modifying the approach to patients with psychosomatic conditions necessitates simultaneous attention to the mental health and emotional capacities of physicians, fostering interdisciplinary collaboration, and revising the culture of medical education.