A 43-Year-Old Lady Arrives at the Clinic for a First

A 43-year-old lady arrives at the clinic for a first consultation because she is experiencing chronic stomach discomfort, overall weakness, decreased appetite, and dizziness. She claims that the pain is wrecking her life and that her previous doctors may have overlooked something. The patient had been hospitalized three times in the last several years with identical symptoms. Despite comprehensive workups, including many abdominal CT scans and an exploratory laparotomy, no reason for the discomfort has been established. The patient has had persistent stomach discomfort since adolescence and is concerned that the over-the-counter medicines she is taking are inadequate. She has no mental diagnosis or a history of substance addiction. The physical exam, vital signs, and laboratory tests (including a chemical panel, complete blood count, and urinalysis) are all within normal ranges. Which of the following is the most appropriate next step in the management of this patient?

A) Explain that symptoms are psychological in nature
B) Obtain gastroenterology consult
C) Order abdominal MRI scan
D) Prescribe an opioid analgesic
E) Reassure that all tests are negative and further workup is not indicated
F) Refer for psychiatric treatment
G) Schedule regular outpatient office visits