This is a transcript of a learning simulation for primary care clinicians to teach how to identify and manage patients who have mental health disorders such as: depression, substance use disorders, Generalized Anxiety Disorder (or GAD), and Post-Traumatic Stress Disorder (or PTSD). Users learn common risk factors and warning signs in patients for mental health disorders and screening tools to evaluate the patient’s level of risk. The simulation includes three practice conversations for learning effective conversation techniques for assessing a patient’s condition, collaboratively exploring treatment options, and making referrals to treatment.
DR. RODGERS: Hi. I’m Austin Rodgers, and I’m a family physician. As primary care providers, we know that identifying and managing patients who have mental health disorders is important because the physical and mental wellbeing of our patients are often very closely connected. We also know this can be challenging, especially when we’re pressed for time and, after all, we’re not mental health experts.
DR. EBER: This is where I come in! I’m Linda Eber, a psychiatrist with over 20 years of experience working with primary care clinicians. Dr. Rodgers asked me to join him today to help him improve his skills at identifying and managing patients with mental health concerns; and I’m so glad he did because primary care visits have a significant psychosocial component.
DR. RODGERS: And because these patients can present with physical, not only mental, complaints, they’re the ones who keep coming back without recovery. So they might be the patients we see most frequently.
DR. EBER: Right. Patients with mental health disorders often seek help from their primary care providers instead of going straightaway to a mental health professional. This is why primary care providers are in an ideal position to recognize warning signs and manage treatment. Today we’ll talk about four common mental health disorders: depression, substance use disorders, Generalized Anxiety Disorder (or GAD), and Post-Traumatic Stress Disorder (or PTSD). Left untreated, all four can have lasting impacts on patients’ physical health and quality of life. They can also lead to suicidal thoughts and attempts. Think about some reasons why patients who are at risk for mental health disorders might go unidentified or untreated in the primary care setting.
Which of these can you relate to?
PCPs lack training/knowledge about mental health disorders.
PCPs are uncomfortable identifying, screening, and treating such patients.
PCPs don’t have time to question patients.
PCPs don’t have relationships with mental health experts.
PCPs/patients have stigma about mental health disorders.
Patient insurance does not cover mental health services.
Patients fail to follow through on treatment plans.
DR. EBER: Lack of insurance may always be a barrier. But, some mental health screenings and consultations are covered by insurance companies. Codes vary by state and insurance provider, so it may be helpful to have someone in your office look up those applicable to your practice and have them on hand. For more information, visit the “Resources” section at the end of this transcript.
DR. RODGERS: In my office, the biggest challenge is time. I see a lot of patients each day. I wish I could spend more time talking to them, but my schedule only allows about 15 minutes, tops, with each. This is something I always struggle with; and it’s really the reason I want to learn more about this.
Recently, I had a visit with a patient of mine named Vanessa. She just graduated from law school, and she’s been my patient for a few years now. About six months ago, she started coming in more frequently, complaining of insomnia and digestive problems. We talked about making diet and lifestyle changes, but, at her last visit, she showed no improvement. She also seemed anxious, fidgety and she’d lost a good deal of weight over the last six months. Here’s how our conversation went:
DR. RODGERS: I’m thinking we should try medication for a few weeks and see if that helps. If it doesn’t, I can send you to a gastroenterologist for some tests.
VANESSA: Actually… I was looking at my symptoms online and it seemed like a lot of them correlate with stomach cancer.
DR. RODGERS: (voiceover) Vanessa’s response, coupled with her anxiety, prompted me to ask a few more questions about other things in her life.
DR. RODGERS: Vanessa, how’s everything going? I know you’ve been studying for the bar exam?
VANESSA: (sigh) I should be. But with my stomach, I just can’t concentrate. At night I lay awake and think about how far behind I am in my studying. There’s just a lot going on right now.
DR. RODGERS: Like what?
VANESSA: It’s just… everything. I’ve been thinking about moving. Plus I’ve been fighting with my family, and now the stomach problems.
DR. RODGERS: You sound really overwhelmed. End of conversation with Vanessa.
DR. RODGERS: I realized that Vanessa’s physical and emotional symptoms were directly related, so I referred her to Dr. Eber.
DR. EBER: I’ve been seeing Vanessa regularly and updating Dr. Rodgers on her progress. She’s doing much better and her insomnia and digestive problems are slowly subsiding.
DR. RODGERS: I keep thinking about how I almost didn’t question Vanessa further because of the pressure of my full schedule of patients. Frankly, a conversation like the one I had with Vanessa was… out of the ordinary for me, and I need to learn some tangible techniques that I can carry out in time-efficient ways.
DR. EBER: (to user) I know that, as a primary care provider, it might not seem like your responsibility to diagnose and treat mental health disorders. But there are common risk factors and warning signs you may recognize in patients. We’ll discuss those today, as well as effective conversation strategies for quickly learning more about a patient’s condition, discussing treatment options, and making referrals. We’ll also talk about some screening tools that you can use to gain insight into your patients’ mental health and follow-up best practices to increase patient adherence with treatment plans. DR.
RODGERS: (to user) You will help me put these techniques into practice by engaging in conversations with two virtual patients. You will help me put these techniques into practice by engaging in conversations with two virtual patients. Let’s get started!