Distress in postural orthostatic tachycardia syndrome (POTS) is largely driven by ineffective healthcare, not patients' attitudes.

This article argues that the emotional distress and mental health burden seen in many people with POTS comes far more from ineffective healthcare experiences than from patients’ own attitudes or personalities. Blitshteyn and Grubb emphasize that POTS is a real, often disabling physiological condition that is frequently misdiagnosed, dismissed as anxiety, or poorly managed due to lack of clinician knowledge and fragmented care. These system-level failures—long diagnostic delays, invalidation, lack of treatment options, barriers to specialty care, and inadequate accommodations—drive frustration, anxiety, and depression in patients who are otherwise motivated to get better. The authors caution against framing POTS distress as primarily psychological or ‘catastrophizing,’ and instead call for better education of clinicians, earlier accurate diagnosis, comprehensive management (volume expansion, medications, physical reconditioning, and support for comorbid conditions), and more validating, collaborative communication. They imply that when patients receive knowledgeable, respectful care and effective treatment plans, distress typically decreases, underscoring that fixing the healthcare response to POTS is central to improving patients’ quality of life.