The interview
Chuck Rose's animation walks us through his drawing of a beach house. He starts with an outline, some contours, a few guiding marks on the page. Gradually he builds up the image, adding details, depth, and color.
My first interview with a patient seems remarkably like Chuck's animation. I start with a few details: name, marital status, chief complaint (like anxiety, or depression). I have a bit more than one hour to form an idea of this patient in my mind, with a tentative diagnosis.
The interview is constructed to try to get specific information, and help the patient feel comfortable sharing it. (Who's comfortable at their first visit to a psychiatrist?! We have some hurdles that Chuck lacks.) What has she been doing up to this point? Can she tell me about important people and events in her life? What sorts of things has she been going through, and what has it been like for her?
I'd like to have a mental image of this unique person, doing something. (Such as, "leaping before she looks," or "not thinking before she acts." Or any number of things that can cause problems.)
But since I'm constructing an image for myself...I have to be careful. How good is my idea of the patient? Is it leading me in the right direction? I ask, and ask again. The image is bound to change as I learn more about the patient, and as the patient learns more about herself.
If we don't question and refine it, my formulation won't help me or the patient. We'll just have something suitable for framing...like Chuck's beautiful beach house.
My first interview with a patient seems remarkably like Chuck's animation. I start with a few details: name, marital status, chief complaint (like anxiety, or depression). I have a bit more than one hour to form an idea of this patient in my mind, with a tentative diagnosis.
The interview is constructed to try to get specific information, and help the patient feel comfortable sharing it. (Who's comfortable at their first visit to a psychiatrist?! We have some hurdles that Chuck lacks.) What has she been doing up to this point? Can she tell me about important people and events in her life? What sorts of things has she been going through, and what has it been like for her?
I'd like to have a mental image of this unique person, doing something. (Such as, "leaping before she looks," or "not thinking before she acts." Or any number of things that can cause problems.)
But since I'm constructing an image for myself...I have to be careful. How good is my idea of the patient? Is it leading me in the right direction? I ask, and ask again. The image is bound to change as I learn more about the patient, and as the patient learns more about herself.
If we don't question and refine it, my formulation won't help me or the patient. We'll just have something suitable for framing...like Chuck's beautiful beach house.
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2 Comments:
I think that taking a history from a patient is more like unpacking a box that has been carried in with them.
You start taking things out one by one, there are things they want to show you, some you have to ask for, some you recognize, some you put on a shelf to look at later.
Then your job is to arrange and rearrange the things with regard to time or type and patterns emerge. But you have to be your own critic as well as critical of the way things are presented or sometimes are attempted to be hidden from view.
How many ways can you arrange these things? The most attractive or intriguing may not make the most sense.
blondzila: It's a constant challenge, sifting through evidence, thinking, and thinking some more. (Sometimes the patient resists revisions, too.)
greg p: I like your analogy! (I moved recently, and right now I'm surrounded by half-unpacked boxes. We still can't find our silverware.) In psychiatry, we seldom reach the bottom of the box!
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