A mental health GP consultation. One of the most common things a GP will deal with, along with headaches and back pain. Throughout the last 2 years of clinical training, I have observed dozens of these consultations, and I have found it incredibly interesting to see how differently doctors deal with these patients. This scenario in particular is based on a memorable consultation, where the doctor was so nice, almost too nice, if such a thing exists, and the patient was rather defensive and abrupt. Writing this script involved me mentally sifting through the various approaches that I have witnessed in a patient-doctor mental-health consultation, which made me realise how many contrasting scenarios I have seen. There's nobody to say which were better than others: some doctors were very passive, allowing the patient to speak for as long as they desired, whereas other doctors were active, asking questions relating to the diagnosis they had in mind. They are contrasting, but both effective in their differing ways. I think this task has made me realise that the important part isn't choosing the right approach, but tailoring the approach to fit the needs to each individual patient that walks through the door.
Setting: GP Surgery, patient walks into the room
Doctor: Hello Miss Evans,
Patient: (avoiding eye contact) Hello doctor Clarke.
Doctor: (smiling) What can I do for you today?
Patient: (looking down at hands, fidgeting) Well, I’ve just not been feeling myself lately, and my friend persuaded me to come here today
Doctor: (stops smiling) Okay, well that’s really good that you’ve come in today. Can you tell me a bit more about how you’ve been feeling?
Patient: (quietly) Ummm, well, I’ve just not been myself. Feeling rubbish, I don’t want to leave the house, I don’t want to see my friends. I’m normally really sociable so I don’t understand it at all.
Doctor: Ok. I’m sorry to hear that Mrs Evans.
Patient: (looks upset) Oh, I’m not a ‘Mrs’, it’s miss.
Doctor: Oh, my mistake, ‘Miss’ Evans. Apologies. Can you think of any reason why you’ve been feeling like this lately?
Patient: No, that’s why I’ve come to see you. If I knew why, I’d be able to sort it out myself wouldn’t I?
Doctor: Yes, fair enough. So how long have you been feeling like this?
Patient: Oh, probably about 3 months.
Doctor: And did anything happen 3 months ago that may have sparked this off?
Patient: Well, I did split up with my long-term boyfriend around that time I guess...
Doctor: Right, okay, and before that, were you feeling absolutely fine?
Patient: Yes, after I split with my boyfriend, it started. And it’s getting worse.
Doctor: Ok. Thank you for sharing this with me. Is there anything in particular you were hoping I could do for you today?
Patient: (looks a little taken aback) I don’t know, make me better?! That’s why I came here, isn’t that rather self-explanatory? I knew I shouldn’t have come (looks like she’s about to cry) – there’s nothing you can do is there? I’m just a mess.
Doctor: No, you did the right thing to come here today.
Patient: Oh, oh, ok.
Doctor: Do you mind describing how your mood has been lately?
Patient: Oh, pretty low, probably explains why I don’t want to leave the house.
Doctor: Ok, thank you for telling me this. Has your mood ever been so low that you’ve had thoughts that you’d rather not be here anymore?
Patient: What do you mean, not be in the doctors surgery? Yeah of course I have, I didn’t want to come here in the first place, I was forced!
Doctor: Sorry, let me rephrase that. I mean, have you ever had thoughts about ending your life?
Patient: (looks up from her hands) Oh God no, don’t be ridiculous, what kind of question is that?!
Doctor: Apologies, but it is an important question to ask.
Patient: Ok ok I understand.
Doctor: How would you feel if I told you that you might be suffering with depression?
Patient: Umm, yeah one of my friends may have mentioned that. But I don’t want any of those tablets that change your brain, make you feel all numb like your head’s in the clouds I’ve heard.
Doctor: Well, I was actually going to suggest that you might benefit from some antidepressant tablets. Most people don’t actually feel those affects you just mentioned, and if they do, they usually disappear within the first 2 weeks.
Patient: Right, ok, I’m not sure about this doctor.
Doctor: Of course, it’s up to you, if you’d rather not take the tablets, that’s absolutely fine. I believe you would benefit from them, but there are other options such as talking therapies.
Patient: Oh god no, I think I’d rather the tablets than bloody Alcoholics Anonymous for the crazies.
Doctor: Some people find the talking therapies useful too, a combination is usually the best option.
Patient: I’ll try the tablets, and I’ll think about the talking groups another time. Is that allowed?
Doctor: Of course. Whatever you feel would suit you. Would you like me to talk you through the tablets, then you can make your decision?
Patient: (smiles meekly) Yeah sure, go on…