Honestly, as a mid-level I WISH I had this kind of instruction. There are so many times I wish I could go back in time and adjust the way I had questions just because it didn't feel "right" and I understand why. Part of it is patient volume but the other part is just not knowing the best way to approach the situation, especially with patients in military. Thanks Preston.
I didn’t realize I had it even knowing the criteria because that’s not how I describe things. It doesn’t feel like excessive guilt or negative self talk or hopelessness. It’s basic accountability and high standards and a pragmatic view of the future. I’d always felt this way so my scale was calibrated wrong.
Med student here, thanks for the pearls! I appreciate it a lot even though I don't want to do psych. I think that a lot of the other specialties really lack the holistic approach. Just because someone became ID doesn't preclude them from needing to treat the human in front of them.
Coming from a first year medical student, your videos are always so insightful and interesting! I will definitely integrate this to my practice when I get there
When I went to the doctor last, the nurse(?) had a mental health screening. She was very nice and she assured me that there was no shame, they give everyone this screening and they just want to get people the help they need. She was very open and when I wasn’t sure how to answer a question, she would talk through it. I wasn’t nervous about it all, I’m very in favor of talking about and treating mental health, and it’s a big issue right now. But I’m glad to see it being handled so well and I bet she’s made a difference to someone.
very insightful, thank you! just one little addition: if we're gonna talk about how to properly diagnose depression, can we PLEASE not forget the time criteria. I see a lot (like, A LOT) of patients with a diagnosis of "depression", who are on antidepressants which - suprprise - aren't helping and possibly giving nasty side effects, because actually, they have depressive *symptoms* for hours or days at a time due to emotional instability. Never forget to check if there are actual episodes, please and thank you
Thanks for this video, I am a paramedic in a very rural area and often my transport times are 1-3 hours. Having the time to do an extended history is something I have the luxury/curse of doing and I want to try to implement some of your points on my next opportunity.
Totally agree. I feel like the same way we translate other symptoms into medical terminology without patients needing to say it (e.g., my legs swell up and i have trouble breathing any time i go upstairs -> lower limb edema, possible cardiogenic dyspnea) we also need to learn how to translate people’s mental health status by what they’re telling us, as they are probably already communicating what we want to know. Great thought about having the checklist at the back of our minds, it’s really not for them but to remind us if our assessment has been comprehensive! 👏
I find it more clinically useful to ask, do you ever find yourself having the feeling "people would be better off without me"? or asking about other persistent negative ruminations.
Great video - just graduated final year med school in Aus and this will be useful to use in internship next year. Been following from the start and love your work!
Excellent video. Would love it if you did this for other common interview pitfalls. For example, I often find that I'll get dubious reports of auditory/visual pseudo-hallucinations in people that have terrible trauma histories, though I can see they're not disorganised or delusional in their thought. In other words, I don't get the impression of a primary psychotic disorder, though they're clearly suffering. What's your approach to exploring these symptoms?
The guilt item really annoys me: I wish they would replace it with shame. Guilt, to me, is I have some something wrong. This means (in most cases) it can be remedied. But shame is a totally different beast and to my mind for so much better with depression. Shame is far more encompassing and fat more difficult to remedy, which this links with other items in the measure of depression (according to the DSM's categorisations).
I feel like this is just a fundamental problem with detailed mental health assessment - all of these experiences are subjective (to be clear, they are *real*, just not something you can directly measure from the outside), so different people can experience the same broad strokes pattern of disordered function and describe it very differently. Someone tries to boil all that down into a clinical scoring system and gets something that's good enough in the people they tried it on and suddenly the exact phrasing is gospel
Bruh I have most of my physicals are actually 2-3 chief complaints and maybe preventative care. I'm given 15 mins for all of this. Best I can do is my MA handing the patient a PHQ-9 while they are being roomed.
The standard depression screener question "Trouble concentrating on things, such as reading the newspaper or watching television?" is useless and irrelevant in the year of our lord 2024. Would much rather have an open-ended conversation instead of a psychiatrist going down a checklist of screener questions
Just like that Epworth sleepiness scale the sleep clinic keeps handing me. Who is "sitting quietly after lunch without alcohol" and falling asleep? It's like it doesn't know about my phone addiction...
@@wrongname2702 Exactly. Screening questions should be updated on a regular basis to reflect what most people's habits are in real life. This is how diagnoses get missed because people might take the question literally or not understand the question. They might think it doesn't apply to them if the question is misunderstood
Really great stuff. Could you make similar things about elderly mental issues and identifying changes of brain atrophy instead of normalising it to be age related normal changes in memory and behaviour.
I'd really like to know how you go about getting people to agree to therapy or SSRIs when it's apparent there's something going on given that people really hate the labels. I'm FM and it is often apparent even with a normal PHQ9 that there's something up but it's hard to get the ball rolling. There's a lot of barriers, from limited time as a PCP to patient's reluctance to go to a specialist or even come back to talk to me more about it.
Licensed Mental Health Counselor here. My PCP once gave me the PHQ9 as a depression screener in the waiting room before my annual physical. It was a copy of a copy of a copy of a copy, and such poor quality that the entire column of “3’s” on the likert scale (for rating a symptom as “nearly every day”) had disappeared. When I told her this in my appointment, she LAUGHED and said it’s just clinic policy to give everyone a depression screener. Needless to say, she is not my PCP anymore.
The harder part about this is that this is extremely culturally dependent and to some degree dependent on phases of life. Either you get used to it or ask the same questions a few different ways.
This is what i have always thought to be the case, but no MH professional has ever done a good job of asking! One question, what would you do if a patient were to lie about their symptoms/experiences due to embarrassment in answering these questions?
![Kodak Black - Versatile 4 [Official Video]](http://i.ytimg.com/vi/VcP_1Ua__vY/mqdefault.jpg)
"The village idiot trying to put it all together" is such a great way of describing that curious neutrality that encourages people to open up to you.
the columbo approach!
spot on, effective a lot of the times..
The Idiot, by Dostoevsky
ooo "curious neutrality" love that! thanks internet colleagues lol
The checklist is for you, it's not for the patient. What a genius statement.
!! I came to comment just how profound that is😪
surgery resident here. yes to everything
Honestly, as a mid-level I WISH I had this kind of instruction. There are so many times I wish I could go back in time and adjust the way I had questions just because it didn't feel "right" and I understand why. Part of it is patient volume but the other part is just not knowing the best way to approach the situation, especially with patients in military. Thanks Preston.
I didn’t realize I had it even knowing the criteria because that’s not how I describe things. It doesn’t feel like excessive guilt or negative self talk or hopelessness. It’s basic accountability and high standards and a pragmatic view of the future. I’d always felt this way so my scale was calibrated wrong.
Be irritated and then put a cute cat at the end to make us all more inspired to ask better questions! 😂 no seriously this is extremely insightful! ❤
Med student here, thanks for the pearls! I appreciate it a lot even though I don't want to do psych. I think that a lot of the other specialties really lack the holistic approach. Just because someone became ID doesn't preclude them from needing to treat the human in front of them.
Coming from a first year medical student, your videos are always so insightful and interesting! I will definitely integrate this to my practice when I get there
goat. i hope to work with you in the future, -PA-2
Literally rewatching this before triaging a patient: so thank you !!
Cat = serotonin
Maggies like, "I am stealth, I am speed".
Preston I can tell you’re a great clinician, wish we had more peeps like you in the field!
When I went to the doctor last, the nurse(?) had a mental health screening. She was very nice and she assured me that there was no shame, they give everyone this screening and they just want to get people the help they need. She was very open and when I wasn’t sure how to answer a question, she would talk through it.
I wasn’t nervous about it all, I’m very in favor of talking about and treating mental health, and it’s a big issue right now. But I’m glad to see it being handled so well and I bet she’s made a difference to someone.
very insightful, thank you! just one little addition: if we're gonna talk about how to properly diagnose depression, can we PLEASE not forget the time criteria. I see a lot (like, A LOT) of patients with a diagnosis of "depression", who are on antidepressants which - suprprise - aren't helping and possibly giving nasty side effects, because actually, they have depressive *symptoms* for hours or days at a time due to emotional instability. Never forget to check if there are actual episodes, please and thank you
Thanks for this video, I am a paramedic in a very rural area and often my transport times are 1-3 hours. Having the time to do an extended history is something I have the luxury/curse of doing and I want to try to implement some of your points on my next opportunity.
Totally agree. I feel like the same way we translate other symptoms into medical terminology without patients needing to say it (e.g., my legs swell up and i have trouble breathing any time i go upstairs -> lower limb edema, possible cardiogenic dyspnea) we also need to learn how to translate people’s mental health status by what they’re telling us, as they are probably already communicating what we want to know. Great thought about having the checklist at the back of our minds, it’s really not for them but to remind us if our assessment has been comprehensive! 👏
I find it more clinically useful to ask, do you ever find yourself having the feeling "people would be better off without me"? or asking about other persistent negative ruminations.
Great video - just graduated final year med school in Aus and this will be useful to use in internship next year. Been following from the start and love your work!
These are your best videos
Hands down best med content creator. Like im actually going to use this in practice. Incredible
Good way of understanding diagnostic cues
I swear Maggie gets cuter every single time I see her!!!
Omg she’s such a cutie 😻
I really appreciate this man u are a great physician. Always enjoy hearing ur insight, keep it up man!
Future OBGYN here. Very helpful as always 💜
I absolutely love your adorable little Tortie! ❤️🤗😺
Excellent video. Would love it if you did this for other common interview pitfalls. For example, I often find that I'll get dubious reports of auditory/visual pseudo-hallucinations in people that have terrible trauma histories, though I can see they're not disorganised or delusional in their thought. In other words, I don't get the impression of a primary psychotic disorder, though they're clearly suffering. What's your approach to exploring these symptoms?
The guilt item really annoys me: I wish they would replace it with shame. Guilt, to me, is I have some something wrong. This means (in most cases) it can be remedied. But shame is a totally different beast and to my mind for so much better with depression. Shame is far more encompassing and fat more difficult to remedy, which this links with other items in the measure of depression (according to the DSM's categorisations).
I feel like this is just a fundamental problem with detailed mental health assessment - all of these experiences are subjective (to be clear, they are *real*, just not something you can directly measure from the outside), so different people can experience the same broad strokes pattern of disordered function and describe it very differently. Someone tries to boil all that down into a clinical scoring system and gets something that's good enough in the people they tried it on and suddenly the exact phrasing is gospel
Bruh I have most of my physicals are actually 2-3 chief complaints and maybe preventative care. I'm given 15 mins for all of this. Best I can do is my MA handing the patient a PHQ-9 while they are being roomed.
Same here. But maybe then we can schedule a separate consult to properly talk about mental health issues if we spot something is off :)
@@annahernandez3690 Bold of you to assume the patient that never goes to the doctor except for their physical will return for a follow up.
This is rly helpful thanks brother
The standard depression screener question "Trouble concentrating on things, such as reading the newspaper or watching television?" is useless and irrelevant in the year of our lord 2024. Would much rather have an open-ended conversation instead of a psychiatrist going down a checklist of screener questions
Not useless. It’s a balance between the two.
Just like that Epworth sleepiness scale the sleep clinic keeps handing me. Who is "sitting quietly after lunch without alcohol" and falling asleep? It's like it doesn't know about my phone addiction...
@@wrongname2702 Exactly. Screening questions should be updated on a regular basis to reflect what most people's habits are in real life. This is how diagnoses get missed because people might take the question literally or not understand the question. They might think it doesn't apply to them if the question is misunderstood
Wise
But I’m not depressed and when I get home I lie in the foetal position and go to bed 👀
Really great stuff. Could you make similar things about elderly mental issues and identifying changes of brain atrophy instead of normalising it to be age related normal changes in memory and behaviour.
Can you do a video on OCD/intrusive thoughts
Apropos to this - the best recent video I've seen expressing the experience of OCD is one of Stanzi Potenza's shorts
I'd really like to know how you go about getting people to agree to therapy or SSRIs when it's apparent there's something going on given that people really hate the labels. I'm FM and it is often apparent even with a normal PHQ9 that there's something up but it's hard to get the ball rolling. There's a lot of barriers, from limited time as a PCP to patient's reluctance to go to a specialist or even come back to talk to me more about it.
It’s the chunky confused cat for me ☺️
Licensed Mental Health Counselor here. My PCP once gave me the PHQ9 as a depression screener in the waiting room before my annual physical. It was a copy of a copy of a copy of a copy, and such poor quality that the entire column of “3’s” on the likert scale (for rating a symptom as “nearly every day”) had disappeared. When I told her this in my appointment, she LAUGHED and said it’s just clinic policy to give everyone a depression screener.
Needless to say, she is not my PCP anymore.
The harder part about this is that this is extremely culturally dependent and to some degree dependent on phases of life.
Either you get used to it or ask the same questions a few different ways.
This is what i have always thought to be the case, but no MH professional has ever done a good job of asking! One question, what would you do if a patient were to lie about their symptoms/experiences due to embarrassment in answering these questions?
What pen do you use?
I always have to watch these a few times because I get lost in your eyes.
You accepting patients bro? Asking for a friend
Hi❤❤❤
Your like a handsome moai
Yea, you came across as very vexed. Those were some good tips though, thanks