Not a promise of one hidden cause: a bounded clinical account, a ranked differential, selective next steps, explicit stopping rules, and a plan for who owns which part of follow-up.

Referral guidance for Pennsylvania physicians considering an adjunctive consultation for adults with persistent, complex symptom patterns. Scope, exclusions, deliverables, and return-to-referrer behavior.

Patients with persistent or complex symptoms often see several specialists over time. Each may rule out serious disease within its own area, yet the overall pattern remains unexplained.