Patients with ‘medically unexplained symptoms’ (MUS) remain an ongoing challenge to medical practitioners using conventional approaches to diagnosis and treatment. This challenge often creates tensions and defensive enactments in the doctor–patient relationship. In this viewpoint article, a personal reflection from current clinical practice is presented as a catalyst for further dialogue. In particular, psychoanalytic thinking around the issue of MUS is advocated as bringing a valuable focus by looking at ‘meanings’ behind symptoms. Medical practitioners may benefit considerably by working jointly with psychoanalytical practitioners. This could improve the care of patients with MUS and in addition bring beneficial understanding to the dynamics of the patient relationship.