POTS: 800,000 Australians affected but only 2% of GPs trained in it

What just happened

A new ABC Health feature has put postural orthostatic tachycardia syndrome — POTS — back in view, and the picture it paints for Australian women with the condition is not one of a system working well.

About 800,000 Australians are estimated to live with POTS. The condition predominantly affects women, most commonly during ages 15 to 50 — prime working years, child-rearing years, the years when a person presenting with fatigue and palpitations is most likely to be labelled anxious or deconditioned. Symptoms include a racing heart rate on standing, severe fatigue, brain fog, exercise intolerance, and blood pressure instability. They are real, measurable, and significantly debilitating.

Dr Marie-Claire Seeley, who led a survey of more than 2,000 Australian general practitioners, found that only 2% had received any training in diagnosing or treating POTS. Two per cent. In a condition affecting hundreds of thousands of Australians — mostly women in the demographic most likely to be sitting across from their GP trying to explain why standing up makes them feel terrible.

For patients like Piper — a South Australian woman whose family drove approximately 225 kilometres to Adelaide for specialist care — this training gap has direct consequences: missed diagnoses, dismissed symptoms, long specialist waitlists, and significant out-of-pocket costs at every stage.

Both-and

Why the training gap has persisted

POTS has historically sat in a difficult clinical space. It is not a single-organ condition — it spans cardiology, neurology, and general medicine. The autonomic nervous system is not routinely taught in depth in Australian undergraduate or GP training programmes. And for a long time, patients — most of them young women — were told they would grow out of it, or that their symptoms had a psychological explanation.

A 20-year longitudinal study published recently complicates that narrative directly: only 2% of POTS patients recovered after two decades of follow-up. This is not a self-limiting condition. It is a chronic, often severely limiting illness that the system has been underestimating for decades.

Long COVID has changed the landscape somewhat. Post-COVID dysautonomia — including POTS — has brought the autonomic nervous system into mainstream clinical attention in a way textbooks did not. Many GPs have encountered it in significant numbers for the first time through long COVID presentations. That is both an opening and an indictment: a condition affecting 800,000 Australians before COVID required a pandemic before it received serious clinical attention.

The access problem compounds the diagnostic problem

Specialists with autonomic expertise are predominantly in capital cities. Tilt-table testing — the gold standard for confirming POTS — is not available in most regional hospitals. For a woman in rural South Australia, Queensland, or Western Australia, a POTS workup may involve multiple trips across hundreds of kilometres, extended specialist waitlists, and out-of-pocket costs at each stage.

There is no MBS item that specifically supports POTS management. Intravenous saline — used by some patients for acute symptom control — is not routinely funded in the outpatient setting. The coordinated care that POTS requires (GP, cardiologist or neurologist, sometimes a physiotherapist for graduated exercise rehabilitation) is costly and logistically demanding for anyone, and near-prohibitive for someone whose core symptom is that sustained physical effort leaves them worse.

None of this is unique to POTS. It is a pattern seen across conditions that disproportionately affect women and are still catching up on the diagnostic and funding infrastructure they deserve. But it is particularly acute here because the diagnostic delay is itself modifiable — and the modified active standing test needed to detect it can be done in any general practice room with a pulse oximeter and a timer.

What general practice can do right now

The modified active standing test measures heart rate at rest and then at one, three, five, and ten minutes of standing. A sustained increase of 30 or more beats per minute (40 or more in adolescents), in the absence of other explanations, meets the diagnostic criterion. No tilt table required.

That is a feasible screening step in a patient presenting with unexplained fatigue, palpitations, or exercise intolerance — particularly a woman in her 20s, 30s, or 40s, particularly if those symptoms followed a viral illness and have not resolved.

My two cents

The 2% training figure is stark. The more clinically important number might be the 2% recovery rate at 20 years — the number that reframes whether early recognition matters. It does. A condition this limiting, this chronic, and this concentrated in young women cannot wait another decade for awareness to filter into GP training programmes.

If your fatigue and palpitations have been attributed to anxiety, if you feel significantly worse after standing for a sustained period, or if your symptoms worsened after a viral illness and have not returned to baseline: it is worth asking your GP specifically about POTS and the active standing test.

You are not unusual. You are not imagining it. The system is catching up — it is just not there yet.

Verdict: yes — POTS is underdiagnosed, under-resourced, and affecting hundreds of thousands of Australian women right now.

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Sources cited

1. More women being diagnosed with POTS but rural patients face extra toll. ABC News, 19 August 2026. https://www.abc.net.au/news/2026-08-19/pots-women-diagnosis-rural-regional-patients-healthcare-sa/107016870