While driving to the clinic, Ms. Blue thought about what she would tell her doctor. She didn’t want to come across as needlessly anxious, but she wanted him to understand how unwell she felt. Was there something wrong with her?
Fifteen minutes passed before Dr. Rules joined her in the sterile office.
“Hello, Ms. Blue,” he said while glancing at the chart. He dropped himself onto the rolling stool. “What’s going on?”
“Well, I think I might—well, you see, I’ve been really tired lately. There’s been a lot of stress in my life and I haven’t been able to sleep—”
“I’m sorry to hear that,” Dr. Rules said, glancing up from his notes. “How much sleep have you been getting?”
“Oh, I don’t know, maybe four or five hours. I think this is because—”
“How much sleep were you getting before?”
Ms. Blue paused to think. “Maybe seven hours? I’m usually in bed by eleven, eleven-thirty, and up—”
“So that is a change,” Dr. Rules continued. “Have you noticed any change in your appetite?”
“Um, I don’t think so,” she said. “But I—”
“How about your energy? You said you feel more tired now?”
And so it went. When she tried to tell him that her father recently passed away, Dr. Rules interrupted and asked if she had feelings of guilt. Because he then asked about her ability to concentrate, she wasn’t able to tell him that her mother, who had dementia, would likely move in with her family.
“Have you thought about suicide?” Dr. Rules asked.
Ms. Blue looked at him blankly. “No, no. Things aren’t that bad, but I don’t feel—”
“It sounds like you’re depressed,” Dr. Rules said, “but let me listen to your heart and lungs, just to make sure they sound okay.” His gaze settled into the middle distance as he moved his stethoscope first across her back, then over her chest. After quickly pushing on her belly and murmuring, “Everything’s fine,” he dropped back onto the rolling stool and rotated towards the desk. He hastily scribbled something onto his prescription pad, tore the top sheet off, and handed it to her.
“Take this,” he said. “It’s an antidepressant. It might have some side effects, like dry mouth, sleepiness (but you could use that, right?), and problems with sexual climax, but you should start feeling better in a few weeks. I’ll see you in about a month, okay?”
He was already walking away, though he suddenly paused and returned to where she was sitting. Putting a hand on her shoulder, he said, “It’ll get better.”
She walked out of the office, feeling both relief and dismay. On the one hand, Dr. Rules apparently didn’t think that she had a major medical condition. On the other hand, she wondered if he at all understood her current situation and how terrible she felt.
Later on in the day, Dr. Rules pulled Ms. Blue’s chart from the file and reviewed his notes. He looked at the checklist of symptoms for depression and saw that he had checked five boxes.
“Five out of nine means major depression,” he murmured. He continued to mumble to himself as he completed the note.
“Assessment… major depression, mild, single episode. Plan… prescribed an antidepressant for thirty days with one refill. Follow up in one month… repeat checklist at that time…”
He resolutely closed the chart. Diagnosis guides treatment. He had succeeded in both.
This is part of a series about why some physicians write many prescriptions for psychiatric medications. You can read more stories here.
Maria Yang, MD 