A 25-year-old woman comes to the office for an initial evaluation of low mood. Since moving to a new apartment 3 weeks ago, the patient has felt sad and has not been sleeping well. She says, "My landlord won't allow pets in the building. I miss my dog so much. I know my mood would improve if I could get a letter from you saying my dog can live with me." The patient's dog is currently staying with her parents, who live a few miles away from her. Which of the following statements by the physician is the most appropriate?

Question

A 25-year-old woman comes to the office for an initial evaluation of low mood.  Since moving to a new apartment 3 weeks ago, the patient has felt sad and has not been sleeping well.  She says, "My landlord won't allow pets in the building.  I miss my dog so much.  I know my mood would improve if I could get a letter from you saying my dog can live with me."  The patient's dog is currently staying with her parents, who live a few miles away from her.  Which of the following statements by the physician is the most appropriate?

Quizplus · Accepted Answer

In this initial patient encounter, the physician is faced with a specific request for an emotional support animal letter but has very limited information. Although physicians should be responsive to a patient's concerns, they should not feel pressured to make a recommendation before fully evaluating the patient. The best approach is to validate the patient's concerns and gather more information on which to base a decision. The physician should begin with an empathic comment acknowledging this patient's distress and then obtain a more complete understanding of the situation. This would include obtaining a more detailed description of the patient's mood, evaluation for additional depressive symptoms, and medical and psychiatric history as well as an assessment of other psychosocial stressors and the patient's support system. Dismissing the patient's request or coming to a premature decision should be avoided. (Choice A) This statement fails to acknowledge the patient's distress, avoids addressing her request, and offers specific advice without a full understanding of the situation. (Choice B) This statement dismisses the patient's immediate concern as unimportant and focuses on long-term strategies. This approach is likely to frustrate the patient and negatively impact the physician-patient relationship. (Choice D) This statement may make the patient feel defensive about her decision to move. It may be more difficult to do a full assessment if the patient feels judged. (Choice E) Writing a letter is up to the physician's discretion but should not be done before fully evaluating the patient and documenting appropriately. Educational objective: Although physicians should be responsive to patient requests, they should not feel pressured to make a recommendation before fully evaluating the patient. The best approach is to validate the patient's concerns and gather more information. __________ References: Patient-centered communication: basic skills. (http://www.ncbi.nlm.nih.gov/pubmed/28075109)

A 25-Year-Old Woman Comes to the Office for an Initial