What Doctors See When Health Anxiety Walks In

Dr. Karen Bowles is a general practitioner at an academic medical center in the US. She teaches residents, treats patients with complex presentations, and has a background in mindfulness-based interventions. We spoke to her about what health anxiety looks like from the doctor's side of the desk, and why the system often makes it worse before it makes it better.

Watch the full conversation on YouTube.

The patient who keeps coming back

Health anxiety patients tend to present with a pattern that is recognizable once you know what to look for, but easy to miss if you don't. They come in with many different concerns, often a new one each visit. They are usually intelligent, employed, and insured. They seem concerned, not dramatic.

"The person with health anxiety is often very intelligent, working, has health insurance, just seems concerned."

The challenge is that if a patient sees a different doctor each time (an urgent care clinician, a covering physician, an A&E doctor) nobody puts the full picture together.

"If you've never met this patient before, you have to take everything at face value. It's really the primary care person who's going to have to deal with the big picture, but that person could come in five different times before they get back in to see their primary care doctor."

This fragmentation means the pattern goes unrecognised. Each new doctor orders a new test. Each test either provides short-lived relief or introduces new uncertainty.

Why "one more test" does not help

Dr. Bowles was direct about the reassurance trap that plays out in medical settings:

"A lot of people that don't have experience with this presentation think that if I just do one more test, then they'll be reassured. It's not about the testing. It's more about naming the problem and finding an approach that the patient can feel comfortable with."

Testing can actively make things worse. It gives the anxious brain more material to work with: an ambiguous result, a doctor who hedged, a follow-up that feels ominous. Dr. Bowles noted that the way doctors communicate often leaves too much room for doubt:

"Doctors tend to speak in a way that leaves something open for uncertainty. 'It could be this, it could be that, I don't think it's this but you never know.' It just leads people to feel like we don't know what we're doing."

For someone with health anxiety, that uncertainty is not reassuring. It is fuel.

The care gap

Dr. Bowles identified several gaps in how health anxiety is currently handled.

Doctors don't feel confident diagnosing it. She compared it to the push 15 years ago to help primary care physicians recognise depression. Questionnaires were developed, awareness increased. Nothing equivalent exists for health anxiety.

"People lack an ability to feel comfortable in the diagnosis and uncertainty about how to approach this therapeutically."

Therapists aren't always informed either. Dr. Bowles has seen cases where a therapist referred a patient back to a doctor for more testing, the exact opposite of what was needed.

"You might refer somebody to a therapist, but if the therapist isn't informed, they might even be sending the patient to a different doctor to make sure that they get a full evaluation."

Communication between providers is poor. Mental health records are often siloed from primary care records. The GP cannot see what the therapist is working on, and vice versa. A coordinated conversation between providers would speed up the right diagnosis and the right treatment, but that rarely happens.

How she talks to patients about it

Dr. Bowles described her approach when she suspects health anxiety. She starts with the presenting concern, taking it seriously, explaining why the symptom does not match a serious illness given the patient's age, risk factors, and presentation. Then she says something important:

"I do not feel that additional testing will actually help reassure us."

That sentence does real work. It draws a line between the patient's experience (which is valid) and the anxious brain's demand for more data (which will not help). But she does not push the health anxiety conversation in that first visit. Instead, she books a follow-up that is not symptom-generated, a check-in to look at the bigger picture.

"I might ask them, 'Do you have any concerns that one of the reasons that you keep coming back is related to more of an anxiety about your health than a specific health problem?' Because a lot of times people kind of know."

The key, she stressed, is making sure it does not sound judgmental. Health anxiety is not something people are making up. The symptoms are real.

"You really are having chest pain. You really do have a headache. But the thing that's driving that is the anxious thoughts, and we know that anxiety is a physical experience."

The pandemic changed things

Dr. Bowles saw a clear increase in health anxiety presentations during and after the pandemic. The reasons are layered: the genuine threat of COVID, conflicting public health messaging, reduced access to primary care doctors, and an erosion of trust in medical institutions.

"In the US in general now, the fallout of all that is less trust in science and less trust in medical doctors. So it's really hard to form an alliance with the patient."

She also pointed to the broader anxiety landscape: constant information from phones, global uncertainty, and online support groups that can sometimes reinforce unhelpful patterns rather than break them.

What she noticed about the mindfulness approach

Dr. Bowles teaches mindfulness in a healthcare setting and spoke about what she observed in practice:

"The part of you that notices something uncomfortable is outside of the actual discomfort. If we can increase the amount of brain space that is in touch with that noticing, then the actual anxiety or pain is just smaller in our experience."

This is the core principle behind mindfulness-based approaches to health anxiety: not fighting the thought, not arguing with it, but developing the capacity to observe it without being consumed by it. It takes practice, and the relief is not instant. But the evidence supports it as a meaningful part of treatment (Hedman et al., 2011).

What you can do

If this sounds familiar -- the repeat appointments, the tests that never fully reassure, the feeling that your doctor does not quite understand what you are going through -- you are not alone.

• Learn how to prepare for a doctor's visit when you have health anxiety
• Read more about Dr. Karen Bowles
• Explore the treatment approach that combines exposure and mindfulness

This article is for informational purposes only and is not medical advice. If you're concerned about your health or mental health, speak to a qualified professional. If you or someone you know is in crisis, contact a helpline near you.