うつ病で通院中の人　診察室で〇〇を伝えていないなら、損している！#早稲田メンタルクリニック #精神科医 #益田裕介

02:03 First Visit 05:27 Follow-up Visit 06:23 Cognitive Distortions Today's topic will be "What should depressed people tell their doctor? How can outpatient visits be used to learn?" I think there are many people who go to a psychiatrist and don't know what to say to their doctor, or who are unable to answer. I think many people say they're fine even when they're not. The reason is that they don't really know how to have a conversation. I think there are many people, including myself, who can't do it well even when they're told what to do or read the manual. It doesn't matter if it's a machine or anything, even if you don't really understand it even after reading the instructions, and then you see someone using it and think, "Oh, that's how it should be." Seeing is believing, or you can get a sense of the atmosphere and use it well. However, I've never actually seen other people's outpatient visits or consultations, and I don't think I ever will. Even doctors rarely do this, so I don't think patients have any experience with it. They don't even show you what to expect during your consultation. So it can be hard to know what to talk about. Even if you're told to talk freely, you probably don't know how much to talk about. Today, I'll explain the key points. ■Initial Consultation The first consultation is called the "initial consultation," and the second and subsequent consultations are called "review consultations." An initial psychiatric consultation usually lasts between 30 minutes and an hour. You might think that there's a lot of time, but it's actually not that long. Even though it's 30 minutes, it goes by really quickly. You talk, get explanations from the doctor, and quickly implement what you should do, and 30 minutes will fly by before you know it. That's why I think many people feel that it's not enough. You might be wondering, "How can they really understand with this?", but doctors generally know what questions to ask during the initial consultation and what questions will help them decide on a treatment plan. I think you can ask about anything you weren't able to ask about the second time, so the interview usually takes about 30 minutes, but I'll explain what kind of questions I'll ask and what I'd like you to tell me. Current Problems I want to know, "What are you struggling with right now?" It's fine if you can't sleep, can't eat, feel uneasy, or are anxious. After asking a certain amount, if the story gets longer and longer, I'll cut it off. Life History - Current Illness I'll ask about what kind of child you were as a child, how you graduated from university and now join a company as a new graduate, how you were assigned to this department, but your boss was this kind of person and this made you feel depressed, how you gradually started having trouble sleeping, and how you finally managed to get an appointment and came to see the doctor today. Family I'll ask about what kind of family you have, where the father lives, how old he is, what kind of job he does, what kind of person the mother is, and so on. Chronic Illnesses I'll check for any chronic illnesses and determine which medications are appropriate and which are not. ・Work I also ask about what kind of work they actually do. ・Consultations including taking time off work After that, I also discuss taking time off work. I think these are the key points to ask about during an initial consultation with a patient with depression. It would be difficult to answer on the day. It would be difficult to answer quickly in the examination room. Our clinic has an online questionnaire, so first-time patients are asked to fill it out. Some people are unable to fill out the online questionnaire, but we have a medical questionnaire available before the consultation, so we ask them to fill that out. This makes the consultation go quite smoothly, so I ask them to fill out these key points. Of course, since this is the patient's first time filling out the questionnaire, there may be some gaps. I ask about those points during the consultation. The initial consultation involves listening to the patient's questions, explaining the illness, and formulating a treatment plan. ■Return Visit Return visits are often quite short, lasting just 5 minutes or more. Since they are short, I encourage you to use the medical questionnaire or online consultation. During follow-up visits, I ask about the patient's current symptoms, how their depression has improved, how their sleep is, and the effectiveness and side effects of any medications they're currently taking. I also review welfare and paperwork, such as sick leave benefits. I ask questions like: Are you receiving sick leave benefits, and when? Are you receiving support for independent living benefits? Are you receiving a disability certificate? If you're on leave, I ask questions like whether you've communicated with your workplace. I think these are pretty standard qu...