Teaching session worksheet
>click here for printable version<Registrars sometimes have difficulty dealing with sadness, and reactions to strong emotions. Some reasons why this might be the case are listed in bold below and can be used for discussion during the tutorial. This list is by no means meant to be exhaustive and you might like to spend some time reflecting on your own ideas as to why this may or may not be the case. The registrar should have identified two patients from their recent consultations who they felt might have been sad. These patients can be referred to as examples throughout the in-practice teaching session.
As part of their Mental Health Education Program, Block Releases are held for Basic, Advanced and Subsequent term Registrars that cover many aspects of this topic, including, not rushing in to diagnose or prescribe, undertaking a risk assessment, understanding patient context and using the rehabilitation model of management.
This tutorial is an opportunity to consolidate and build on some of this learning in a local setting. It would be useful to ask your registrar if they have attended the Block Release and discuss any pertinent aspects or issues.
Full details of the block release including useful resources are available here.
The learning objectives from the Mental Health Education Program that may be most relevant for the Sad Patient are listed below.
Basic Term Registrars (Module 1)
Objectives
- Increase critical understanding of various models of patient management (including long term management strategies)
- Outline and practice of psychological treatment strategies
- Increase understanding of managing suicidality
- Determine methods of self care and review the importance of peer support
Advanced Term Registrars (Modules 2 and 3)
Objectives
- Understand and recognise the context of adolescent mental health issues in the context of the individual, family, peer group and social setting
- Introduction to assessment and general practice management of mental health issues with more complex underlying co-morbidities
- Develop an understanding of how co-morbidities, including drug & alcohol issues, eating disorders, somatisation, chronic pain and personality disorders interplay with mental health presentations, assessment and management in general practice
- Introducing use of case studies, role play and “fish bowl” scenarios as Registrar education tools in topics of complex mental health presentations
Discussion points for the in-practice teaching session
A. Can we “diagnose” sadness?
As doctors we learn about recognising patterns of illness. Templates are often used to try to match our patients’ symptomatology to specific diagnoses. When we encounter a patient with a cluster of symptoms that don’t quite fit any of these templates we may have a tendency to try and “squeeze them into” a box of best fit, rather than feeling comfortable with a more nebulous assessment of “sadness”.
- Make sure you and your registrar understand what is meant by the concept of diagnostic templates
- What diagnostic labels might be incorrectly applied to a sad patient?
- Discuss the example cases the registrar has provided. Is it possible diagnostic labels that were imperfect matches have been applied? What implications might this have, potentially positive and negative?
B. As a society, do we recognize and accept sadness?
- Has medicalisation of human emotions altered doctors’ understanding of illness and normality? Is this a good thing?
- Have public health education campaigns affected the community’s expectations of the medical system when sadness is an issue? Is this a good thing?
- What societal and cultural factors influence our perceptions of sadness?
- Are GPs increasingly taking on roles that were historically performed by other members of communities? What do you think of this? Does this have any ethical implications for GPs and the wider community?
C. Is it difficult to teach management of sadness due to lack of a formal structure?
- Discuss with your registrar your approach to sadness
- Do you have your own internal checklist that allows you to assess risk and ensures you don’t miss another diagnosis? How do you change your plans for follow up based on your risk assessment?
- How do you respond if the patient is distressed and wants you to do something for them?