Patient Scenario

Browser lacks capabilities required to play.

Upgrade or switch to another browser.

Loading…

INSTRUCTIONS: This is an interactive narrative walking you through a patient scenario. You will receive feedback on responses as you go through the story. You can navigate fully by keyboard. Press the Tab key to move forward through interactive elements (buttons, links), and Shift + Tab to move backward. Press Enter or the Spacebar to select an item. [[Open the door.]]

Emily sighs. She says, "I don't know. I was at my advisor's office when the police showed up. They brought me here." [[Why did the police come to your advisor's office?]] [[What kinds of things were you thinking about?]] [[In the chart, it says that your advisor found you staring at a wall for several hours, and so they grew concerned about you...]]

Emily replies, "I'm not really sure." [[What kinds of things were you thinking about?]]

Emily looks down and holds her head in her left hand. She looks pensive. Finally, she says, "My advisor wanted to discuss a reduced courseload for me." Feedback: This question kept the focus on the patient herself and not on her advisor. It is more important early on to focus on rapport and trust building rather than collateral. [[Have your grades been poor?]] [[Why the reduced courseload?]] [[It sounds like your advisor was worried about your safety. Can we give your school a call?]]

Emily looks upset. Her eyebrows crease and she narrows her eyes. "I was just thinking! Why don’t you talk to me, not my advisor?" Feedback: While getting collateral information is important, it is best to first build rapport and trust with the patient. Focusing too much on the advisor's opinions instead of the patient's experiences makes her feel as if what she is saying is not important.

After reviewing the chart and speaking with staff, you enter the room to introduce yourself to Emily. Emily is sitting at the table, with her head in her hands. She looks up at you as you enter. She says, "Hello." You begin to introduce yourself, but then you are immediately cut off when she asks, "When can I go home?" [[Well, we're only just meeting for the first time today. What brought you here?]]

My grades are fine. [[Why the reduced courseload?]]

Well, it's been harder to study since I left my family in China. I'm an international student. Feedback: Similar to last time, this question kept the focus on the patient herself and not on her advisor. It is more important early on to focus on rapport and trust building rather than collateral. [[Continue with conversation.]]

I don't care about what she thinks! Why does she get to decide whether or not I go? Feedback: Similar to last time, at this stage it is best to first build rapport and trust with the patient. Focusing too much on the advisor's opinions instead of the patient's experiences makes her feel as if what she is saying is not important.

[[Have you ever seen visions or things that others cannot see?]] [[Have you heard noises, sounds, or voices that others don't hear?]] [[Some people have different ways of describing their problem to their family. How would you describe the problem to them?]]

The patient stares at you for a second before placing her hands on her hips. She looks upset. "I already told your staff no! Why does everyone keep asking me the same questions?" Feedback: While these questions ask for important information that will inform the provider's diagnosis, it is best to first build rapport and trust with the patient. In doing so, the patient may share this information as you get to know them and their history and lived experiences.

I can't seem to focus and my homework is taking me much longer than it used to… Feedback: This question connects to the patient on a more personal level. It allows the patient to share the patient's own understanding of his/her problems, and how they would describe such problems to their social network. [[Why do you think that this is happening to you?]] [[What do you think your parents would say about this?]] [[Do you ever feel like people are following you or trying to hurt you in some way?]]

I'm not sure. It's probably just stress and pressure. Feedback: This question is a great way to build trust and rapport with the patient. Asking what they personally believe is happening to them establishes confidence and respect in their autonomy, which in turn builds trust and rapport between you and the patient. You may be able to get more information as you continue your conversation.

I'm not sure. It's probably just stress and pressure. Feedback: This question does well relating back to the information the patient has already shared. The specificity in the question demonstrates you are actively listening and paying attention to their needs and concerns. This also builds trust and rapport because you are expressing interest in learning more about them and their lives, including their social network and culture. [[Ask more about what's been going on.]]

Stop asking me these questions! I'm just a normal person. Your movements seem slow, and it seems to take you some time to process our questions before you respond. [[...]]

That's because English isn't my first language! So of course it will take me longer to process questions! Feedback: This question does not address the patient's context - their lived experiences, social network, culture, and lifestyle. Asking questions like the first two allow you to gather more information on the role of their cultural identity, their social network support, and information on their current and past coping strategies.

My grandmother passed away last year. My father is the oldest, so it was our family’s job to plan the memorial service. I feel like I wasn't able to support my family while I'm overseas… [[Does that make you depressed?]] [[Are you feeling suicidal?]] [[That sounds like such a large burden to bear. How have you been dealing with that?]]

I’ve already said that I’m not depressed and I’m not suicidal! Nobody is listening to me... I'm just a normal woman… Feedback: Depending on culture, patients may not be familiar with how bluntly and how frequently we ask about suicidal ideation. An alternative approach would be to ask for more information on how they take care of themselves when they are feeling a certain way or in a certain situation.

I've just been trying to focus on schoolwork… Feedback: This response is great because you are empathizing and validating how the patient is feeling. By asking how the patient has been dealing with their circumstances, you are showing interest in learning more about them which in turn enables them to share more about their lifestyle, culture, social network, and coping strategies. [[Talk about this more]]

[[Has it ever gotten so bad you started thinking about suicide?]] [[Do you ever think about hurting yourself or someone else?]] [[Is there anything that improves your focusing, such as support from family, friends from back home, or others here in the US?]]

I already told your staff no! Why does everyone keep asking me the same questions? How do I prove that I’m normal? Is it okay if we talk to your school? Why don't you believe my story? We need to hear everyone’s side. It's not fair! Why am I locked in here just because my advisor accused me of something? No one is listening to me… Feedback: This question is impersonal and may come off as accusatory or presumptuous of the patient's condition. It's important to learn about the patient's upbringing, values, and social supports to have a bigger picture.

I think it should be someone like a boyfriend or a parent back home. It’s been difficult because I’ve been so busy with schoolwork. It must have been hard to adjust to such a new environment. Well.. Maybe my grades have been worse recently… But that’s why I want to get back to school as soon as possible before I fall even further behind… Feedback: This question focuses on asking the patient for more information on their family and friends which allows the provider to get a better sense of their support system, coping strategies, and lived experiences. It is more personal and encourages the patient to share more information about themselves that may help inform diagnosis and treatment. [[Ask more about the schoolwork.]]

[[You shouldn’t let schoolwork get in the way of your mental health.]] [[You should take care of yourself before thinking about schoolwork.]] [[It sounds like school is very important to you. Can we talk to your school about why they thought you needed support and what resources they have?]]

You think I don’t know that?! Don’t tell me what to do. Feedback: The question is accusatory and disrespectful. It assumes the patient does not have coping strategies and is lacking knowledge on how to take good care of themselves. It also assumes what the patient's values are. Instead, use open-ended questions and focus on getting the patient to become comfortable with you in sharing more about themselves.

Hmm… I guess if it helps me transfer back more quickly... Feedback: This question is framed around the patient's concerns and gathering more information on the type of supports and resources the patient has in their life. This allows you as the provider to better understand what external stressors and factors should be considered when determining the diagnosis and treatment. [[Final feedback and summary of the case.]]

In this scenario, the provider connected to the patient by exploring her beliefs about her problems, learning about her support network, and centering the conversation on the patient. Click here to go back to the [[Start]]