Critics have repeatedly appealed to the metaphysical basis of medicine to account for observed dehumanizing tendencies. In particular, metaphysical dualism and reductive physicalism have been identified as ethically untenable positions. This line of critique rests either on theoretical grounds or empirical research that implicitly assumes that metaphysical beliefs are temporally consistent and formed independent from situational pressures. Turning away from this assumption, this study attends to metaphysical commitments as contributions to an ongoing care relationship emerging from individual patient-physician interactions. In three online focus group sessions, medical students were prompted to explicate their clinical reasoning in response to a patient vignette depicting a case of medically unexplained symptoms (MUS). The recorded responses were then coded and analyzed with a focus on metaphysical reasoning. Considering the students’ responses in light of concepts from the work of Byron Good and Wilfrid Sellars revealed a more nuanced and dynamic engagement with metaphysical questions than has been represented in the literature.