The practitioner established the purpose of the meeting by asking “Do you have a sense of why you are here?”. However, the response of “my doctor sent me” should have been explored further to establish if the patient (Tony) truly understood why his doctor made the referral. PCPs are at the forefront of care in identifying mental health disorders, and at-risk individuals and providing the requisite referrals to mental health practitioners (Zuckerbrot et al., 2018). Education is a big part of mental health management and ensuring that the patient understands the mental health condition should start at the beginning of care to ensure compliance. Psychoeducation is key to successful intervention (Thapar, 2018).
The practitioner also did a good job of summarizing the salient points of the encounter and elicited a time frame from the patient. This yielded more information as the patient was able to identify a triggering event – the break-up with his girlfriend. This also made the patient reveal his suicidal ideations which the practitioner was able to explore. However, the practitioner did not introduce herself nor did she explain to the patient the confidential aspects of the encounter. There was also, no evidence of collateral and prior consent from legal guardians. Using the word “depressed” might not sit well with a patient as he may struggle to accept being depressed because of the stigma associated with mental illness (Radez et al., 2020) YMH Boston Vignette 5 video Discussion essay.
When the patient stated that he feels edgy, like fighting someone, the practitioner noted that “we can definitely talk more about that” but never did. The patient also noted that playing basketball was a hobby he used to enjoy. Talking more about this hobby would have helped the patient to relax more (I observed him to be guarded, hesitant with answers, and make intermittent eye contact), establish a rapport, and be more engaged in the encounter (Carlat, 2017). The practitioner quickly moved on to talk about what the patient does not enjoy – homework, putting him more on the defensive. Tony also mentioned having a beer or two with friends – the practitioner did not ask about frequency and access and neither did she ask about the use of recreational drugs which is common in adolescence (Carlat, 2017).
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