A 30-year-old woman comes to the office due to depressed mood. The patient has felt "disappointed and sad" since she was passed over for promotion 3 weeks ago. She has trouble falling asleep because she thinks about what she could have done differently at work. The patient's appetite, energy, and concentration are not affected, and she still enjoys going out with friends and attending choir group. She has no significant medical or psychiatric history. Vital signs and physical examination are within normal limits. A course of psychotherapy is recommended, to which she responds, "Have you ever had depression or been in therapy, doctor?" Which of the following is the best response to this patient?

Question

A 30-year-old woman comes to the office due to depressed mood.  The patient has felt "disappointed and sad" since she was passed over for promotion 3 weeks ago.  She has trouble falling asleep because she thinks about what she could have done differently at work.  The patient's appetite, energy, and concentration are not affected, and she still enjoys going out with friends and attending choir group.  She has no significant medical or psychiatric history.  Vital signs and physical examination are within normal limits.  A course of psychotherapy is recommended, to which she responds, "Have you ever had depression or been in therapy, doctor?"  Which of the following is the best response to this patient?

Quizplus · Accepted Answer

Patients may ask various types of questions, from inquiries about the physician's professional qualifications and experience to more personal questions about the physician's background and life experiences (including age, marital status, children, and similar experiences such as cancer, a particular medical diagnosis, and loss of a loved one). Some may be especially curious to know personal details that relate to their own life struggles, often triggered by unspoken hopes and fears about whether the physician will be able to help them. Although being responsive to a patient's questions can enhance a trusting relationship, physicians should not feel pressured to respond to questions that they find overly personal or intrusive. However, physicians can maintain boundaries while also gently exploring why the patient is asking. This approach can be helpful in gaining a deeper understanding of the patient's concerns. Querying about what makes this patient ask the question may reveal specific concerns about whether the physician understands her emotional pain and may allay possible fears about psychotherapy. The physician can then more effectively support the patient and address these concerns. (Choice A) This response ignores the patient's question and attempts to provide general reassurance. It would be more productive to try to identify and address the patient's specific issues. (Choice C) Although this statement sets a boundary with the patient, it misses the opportunity to explore deeper concerns that may underlie her question. (Choice D) This response prematurely assumes what the patient is feeling. Exploring the reason for her question in an open-ended manner is more likely to reveal her specific concerns and help her feel understood. (Choice E) This response is defensive in tone and may damage the physician-patient relationship. Educational objective: Physicians should not feel pressured to respond to questions that they find overly personal or intrusive. Exploring why patients are asking is a helpful strategy that can assist the physician in gaining a deeper understanding of their specific concerns.

A 30-Year-Old Woman Comes to the Office Due to Depressed