What is the next best step in treatment for a patient experiencing unexplained symptoms and a PHQ-15 score of 20?

In the context of a patient with unexplained symptoms and a high PHQ-15 score of 20, which indicates significant somatic complaints, scheduling regular outpatient visits is the next best step in treatment. This approach focuses on establishing a consistent therapeutic relationship and monitoring the patient's evolving symptoms without immediately escalating to diagnostics or interventions that may not address the underlying issue.

Regular outpatient visits allow for ongoing assessment, reassurance, and support while helping the patient manage their symptoms over time. This strategy is particularly important in cases where somatic symptom disorder or other functional syndromes are suspected, as these conditions often require a supportive and communicative relationship with healthcare providers to help patients navigate their symptoms rather than implementing potentially invasive or unnecessary procedures.

While referrals to specialty care or additional diagnostic testing (such as endoscopy) might be appropriate in certain instances, they can sometimes lead to increased anxiety or unnecessary medical interventions if the symptoms do not have an identifiable medical cause. Empirically prescribing antibiotics without evidence of infection could also be unwarranted and may contribute to antibiotic resistance.

In summary, scheduling regular outpatient visits allows for a tailored and patient-centered approach, fostering an environment for gradual improvement while keeping the patient actively engaged in their healthcare.