40-year-old woman in depression

The answers given by the SP will be given in parentheses.

• In the whole patient encounter the SP will be in a disinterested mood and talk in a feeble voice.  But the doctor should always make eye contact with the patient.

• The bored responses from the patient should not frustrate the doctor.

Simulated encounter

• "Hello Mrs. Jones. My name is Dr. Smith.  I’d like to ask you a few questions and do a physical exam. Is that ok with you?" (The SP will nod feebly)

• "What brings you in today?" ("I don’t know Doctor. I feel a bit down.")

• "How long have you been feeling this way?" ("Maybe, three months.")

• "Mrs. Jones; do you have any idea why you’re feeling this way?" (She remains silent)

• "Mrs. Jones; I know that you’re in a lot of emotional stress.  Will you talk with me about how you’re feeling and what’s worrying you?" (The patient looks at the doctor and then away)

• "Is there anything in particular that has brought this on?" ("I don’t think so.")

• "Do you have anybody to talk to you when you feel down?" "(I have an aunt. She lives far away.")

• "Mrs. Jones,.. how’s your appetite?" ("I don’t feel like eating.")

• "Mrs. Jones,.. have you lost or gained any weight lately?" ("I’ve lost about seven pounds this past month.")

• "How have you been sleeping?"("I get up early in the morning.")

• "Are you feeling guilty about anything?" ("I don’t think I am being a good mom for my children.")

• "Do you feel abnormally tired?" ("I have no energy at all. I don’t even want to get out of the couch.")

• "Mrs. Jones,…tell me about your daily routine." ("I am a house wife. I do the housework and cook for my children. That’s about it.")

• "Can you tell me about your hobbies and interests?" ("I play the violin and sing in the choir on Sundays.  However, don’t feel like doing that anymore.")

• "Do you have trouble concentrating?" ("Mmm, I don’t know.")

• "Do you find yourself forgetting things?" ("Yeah, I’m forgetting to pay the bills on time. Etc")

• "What’s your favorite thing to do?" ("Spending time with my children.")

• "Are you still feeling that way?" "(I don’t feel like I want to be with anybody, right now.")

• "Mrs. Jones… have you ever felt like life wasn’t worth living? Have you ever thought about killing yourself?" ("Yeah, a couple of times.")

• "Do you ever think about how you would do it" ("No")

• "Do you have guns or pills at home?" ("Yeah, I have a .32 at home.")

• "Do you feel cold when others don’t?" ("No")

• "Are you losing any hair?" ("No")

• "Do you hear things or see things that other people don’t?" ("No")

Do an MMSE at this juncture

• "Do you think something is wrong with you?" ("Yeah")

• "Are you willing to get help from a counselor?" ("I don’t know.")

• "Would you talk with a counselor if I set it up?"("If you think that would help me.")

"Now, I need to ask you a few questions about your health in the past. Is that ok with you?" ("Yeah")

• "Have you ever been hospitalized?" ("No, except for having my children.")

• "Have you ever felt like this before?" ("No")

• "Are you on any medications?" ("No")

• "Do you have allergies of any kind?" ("None that I know of.")

• "Do you have any problems with your urination?" ("No")

• "Are your bowel movements regular?" ("I have been constipated lately.")

• "Have you ever had any shortness of breath." ("No")

• "Have you had any chest pain?" ("No")

• "Have you had a cough that just wouldn’t go away?" ("No")

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