depression on one’s own to managing diabetes or high blood pressure on one’s own. is as much a medical illness as diabetes, arthritis, or high blood pressure, …
|Patient disagrees with diagnosis |
|Script |
|You told me that you dont believe that you have clinical |
|depression If you dont have depression, what is that you think is|
|going on that is causing you to be so unhappy so much of the time? |
|What to do |
|Allow the patient the right to make his or her own decision and |
|choices |
|Tell the patient that in any given year, 10 of the population |
|suffers from a depressive illness |
|Go over the symptoms checklist with the patient and discuss the |
|individual symptoms that the patient is experiencing and discus that|
|depression is a combination of these symptoms |
|Directly state that you believe the patient is dealing with |
|depression and that you recommend he or she begin some treatment for|
|it |
|Suggestions for the patient
|
|Express your concerns about the diagnosis to your regular doctor |
|Ask someone who knows you well whether or not you seem depressed or |
|down |
|Patient doesnt understand seriousness of need for treatment |
|Script |
|Earlier you told me that the depression symptoms you are |
|experiencing have not been a serious problem for you in your |
|day-to-day life Are there any aspects of your life your depression|
|might be interfering with, like your job, your social life, your |
|marriage or your family life? |
|What to do |
|Explore reasons for the patients lack of concern |
|Is the patient in denial about depression? |
|Does the patient have other worse problems in life? |
|Discuss with the patient the need for actively managing depression |
|Compare managing depression on ones own to managing diabetes or |
|high blood pressure on ones own
|
|Remind the patient that the problem is currently present and usually|
|does not go away on its own |
|Remind the patient about the benefits of treating depression |
| Functioning more easily and effectively |
| Regaining the ability to enjoy family, friends, and interests |
| Normalizing eating and sleep patterns |
|Remind the patient about the possible risks associated with |
|untreated depression |
| Depression becoming more severe or chronic |
| Depression recurring |
| Suicide |
|Suggestions for the patient |
|Think about how this or her current health compares to a time when |
|he or she was feeling his or her best |
|Think about what he or she sees for himself or herself in 3 months, |
|6 months, 1 year, first without treatment, then with treatment |
|If he or she knows anyone who has been depressed for a
long time, |
|think about how that person could benefit from treatment |
|Produce a timeline of when the depression and accompanying symptoms |
|appeared during his or her life |
|Ask someone who is aware of the patients functioning if they have |
|noticed any changes that seem to be associated with a depressed or |
|down mood |
|Patient doesnt see that treatment will address problem |
|Script |
|Earlier you told me that you didnt think receiving treatment from a|
|provider for your depression symptoms will be helpful Do you |
|remember me telling you that depression is a medical illness? |
|Depression is as much a medical illness as diabetes, arthritis, or |
|high blood pressure, and needs to be treated by a qualified medical |
|professional just as those illnesses do If left untreated, |
|depression can do just as much damage, and compromise the quality of|
|your life as much, as any other illness |
|Suggestions for the patient
|
|Think about what would have to happen for him or her to feel better|
| |
|Tell you if he or she knows of anyone whom medication or therapy has|
|helped with a similar problem |
|Patient uncomfortable talking about personal issues with doctor |
|Script |
|You told me that discussing your depression with your provider would|
|make you uncomfortable Can you tell me more about that? What is |
|it about talking to your provider about depression that would bother|
|you? |
|What to do |
|Attempt to ease the patients concerns about the provider reacting |
|negatively to the patients personal revelations or not taking the |
|patients problems seriously |
|Emphasize the providers special training in treating depression |
|Tell the patient that the provider treats these problems in one out |
|of every five patients he or she sees
|
|Remind the patient that depression affects her or her physical |
|problems |
|Inform the patient that the provider can treat physical problems |
|better if he or she knows about the patients depression |
|Remind the patient of the providers compassion for his or her |
|patients |
|Suggestions for the patient |
|Recall a time when he or she and the provider talked about other |
|life issues or concerns besides physical health problems |
|Think about and rehearse what he or she can say to the provider |
|about depression |
|Patient is embarrassed about what family and friends would think |
|Script |
|You were saying earlier that it would embarrass you if your friends |
|or family members knew that you were receiving treatment from a |
|provider for depression Can you tell me whose reaction |
|specifically it is that youre concerned about, and
why that is? |
|Care Manager Interview Options Choose from the following A-E |
|Depending on how the patient responds, do one or more of the |
|following: |
|Remind patient all communication is confidential |
|Script: All of the communication that you have with your clinicians |
|is confidential This includes the details of your treatment |
|These details do not need to be discussed with anyone outside the |
|doctor-patient relationship There is no way anyone will find out |
|about your being treated for depression unless you choose to tell |
|them |
|Attitudes of family and friends can change |
|Script: Sometimes the attitudes and beliefs that family members and |
|friends have about depression treatment can change once they see the|
|benefits of treatment |
|Discuss the objections expressed by others about depression |
|treatment |
|Talk with the patient about objections family
members, friends, and |
|co-workers have expressed about other people seeking help for |
|emotional problems Attempt to address those with the patient |
|Explore issues about negative attitudes |
|Explore with the patient any issues he or she might have pertaining |
|to peoples negative attitudes toward being diagnosed with or |
|treated for depression |
|Explore reactions of other peoples family and friends |
|Ask the patient if anyone else he or she knows has been treated for |
|depression, and if so, what the reaction was of this persons family|
|and friends |
|Suggestions for the patient |
|Rehearse what he or she can tell family and friends about depression|
|and its treatment Role-play this conversation with the patient, |
|with you taking the patient role and the patient taking the role of |
|a family member or friend |
|Try to imagine the worst thing that might happen if he or she |
|decided to take antidepressant medication
without the support of his|
|or her family and friends |
|Patient feels treatment will conflict with religious beliefs |
|Script |
|Earlier you were saying that you hold religious beliefs that might |
|conflict with your receiving treatment for depression Could you |
|explain those beliefs to me? |
|What to do |
|Try to deal with these beliefs by emphasizing that depression is as |
|much a medical illness as diabetes, arthritis, or high blood |
|pressure, and needs to be treated by a qualified medical |
|professional just as those illnesses do |
|Make sure that patient understands that, untreated, depression can |
|do just as much damage, and compromise the qualify of a persons |
|life as much, as any other illness |
|Suggestions for the patient |
|Talk to a friend who shares his or her religious beliefs about the |
|importance of getting treatment from
the patients perspective, |
|including information on the risks of untreated depression |
|Ask his or her provider to contact his or her minister/rabbi/priest|
|Patient views other medical conditions as more important |
|Script |
|You were telling me that you have other medical conditions that you |
|consider more important for you to deal with than your depression |
|Can you share with me what conditions those are? |
|Care Manager Interview Options Choose from the following A or B |
|Depending on how the patient responds, do one or more of the |
|following: |
|Remind patient all communication is confidential |
|Script: All of the communication that you have with your providers|
|is confidential This includes the details of your treatment |
|These details do not need to be discussed with anyone outside the |
|provider-patient relationship There is no way anyone will find out|
|about your being treated for depression unless you choose to tell |
|them
|
|Attitudes of family and friends can change |
|Script: Sometimes the attitudes and beliefs that family members and |
|friends have about depression treatment can change once they see the|
|benefits of treatment |
|Discuss the objections expressed by others about depression |
|treatment |
|Talk with the patient about objections family members, friends, and |
|co-workers have expressed about other people seeking help for |
|emotional problems Attempt to address those with the patient |
|Explore issues about negative attitudes |
|Explore with the patient any issues he or she might have pertaining |
|to peoples negative attitudes toward being diagnosed with or |
|treated for depression |
|Explore reactions of other peoples family and friends |
|Ask the patient if anyone else he or she knows has been treated for |
|depression, and if so, what the reaction was of this persons family|
|and friends
|
|Suggestions for the patient |
|Rehearse what he or she can tell family and friends about depression|
|and its treatment Role-play this conversation with the patient, |
|with you taking the patient role and the patient taking the role of |
|a family member or friend |
|Try to imagine the worst thing that might happen if he or she |
|decided to take antidepressant medication without the support of his|
|or her family and friends |
Source:icsi.org
