Introduction
The video Psychiatric Interviews for Teaching: Anxiety is a recording of a hospital practitioner psychiatrist, Dr. Beddi, in a therapy session with her patient, Julie Thomas. She is a 48-year-old woman who complains about palpitations and shortness of breath from time to time. Julie has a husband and works as a bank clerk, though she is currently off sick. She believes that the symptoms she experiences occasionally are related to panic attacks, but Dr Beddi thinks there might be a different explanation – anxiety. The doctor and the patient explore the situation together to identify what actually causes Julie’s panic and how they can find a proper solution. This paper analyzes the session demonstrated in the video, discussing the evaluation process, namely the approach to differential diagnoses and therapeutic communication techniques, from a critical perspective. The psychiatrist suggests the differential diagnosis of anxiety, though many serious diseases are common with panic and should not be excluded, and she implements therapeutic communication techniques well, she could have approached the communication from a different angle.
Differential Diagnoses: Anxiety and Panic Attacks
Dr Beddi conducts the therapy session through several steps: taking the patient’s history, assessing insight, and offering an explanation. While the first step primarily involves the patient describing her symptoms and the original reason she started seeing a doctor, the next session stages include the discussion of the probability of differential diagnoses. An electrocardiogram (ECG) performed on Julie demonstrated no heart problems, and she has no risk factors for heart illness (Debs Storey, 2016). These facts lead Dr. Beddi to believe that the symptoms experienced by her patient are not related to any known heart disease but might be associated with anxiety.
However, the scope of differential diagnoses provided by Dr. Beddi appears excessively narrow. Derrick et al. (2019) state that symptoms of panic may “mimic many medical conditions, including cardiovascular and respiratory disorders, hyperthyroidism, and others” (p. 217). These and many other dangerous illnesses are common with panic, and they should not be discounted while treating a patient with panic symptoms. Moreover, researchers report that there is a potential for co-morbid coronary disease even if the patient has a history of anxiety (Derrick et al., 2019). Julie’s symptoms are common, and they do not seem to present enough evidence to focus on anxiety as a differential diagnosis and exclude the possibility of other diseases. Despite the ECG results and the absence of significant risk factors, the potential for heart disease should not be ignored, which is why specific treatment and prevention measures are recommended to avoid the risk of receiving a cardiac illness in the fuimplementedture.
Therapeutic Communication Techniques
During the session, Dr. Beddi implements several therapeutic communication techniques to ensure a positive doctor-patient relationship and mutual understanding. Researchers argue that the quality of the doctor-patient relationship and their agreement can be the key to the effectiveness of medical treatment, especially when it comes to psychiatric therapy (McCabe & Healey, 2018). Therefore, healthcare professionals should ensure that their patients feel understood and see their therapist as a trustworthy person, which is why appropriate communication is a necessary element of therapy. The therapeutic communication techniques used by Dr Beddi can be defined as reflecting on the patient’s experience and involvement in decision-making about medication (McCabe & Healey, 2018). Firstly, the psychiatrist makes a proper conversation with the patient to acknowledge what symptoms Julie has been experiencing, how they make her feel and how they impact her life. Secondly, Dr Beddi expresses her willingness to involve Julie in the process of her medical treatment: the therapist suggests they discuss different solutions to Julie’s problem, such as tablets or talking approaches (Debs Storey, 2016). These facts illustrate that Dr. Beddi can operate therapeutic communication techniques well and establish a positive doctor-patient relationship.
However, the psychiatrist could have approached the session differently regarding her reflection on the patient’s experience. When Dr Beddi asks Julie about the activities she has stopped performing because of her panic symptoms, the patient’s answer is “some personal things” (Debs Storey, 2016, 02:55). There is a chance that the psychiatrist does not feel Julie’s unwillingness to discuss such matters, which is probably why Dr Beddi insists on receiving a more concrete answer and asks again if her patient means her sex life (Debs Storey, 2016). Even though that information may be necessary for therapy and treatment, the psychiatrist could have approached this question more smoothly or checked the notes of Dr. Jones, Julie’s previous therapist, to avoid the situation in which the patient with potential anxiety could feel awkward or uncomfortable.
Conclusion
The differential diagnosis of anxiety suggested by Dr. Beddi is reasonable, but other significant diseases common with panic symptoms should not be excluded, and the therapist could have approached the doctor-patient communication slightly differently, though she operates the corresponding techniques well. The psychiatrist leads the session skillfully, taking the patient’s history, assessing her insight, offering an explanation, reflecting on the patient’s experience and involving her in the treatment discussion. Overall, the evaluation of the patient appears to be performed proficiently, but Dr. Beddi should not have focused on anxiety as a differential diagnosis, and she could have been more sensitive while speaking about the patient’s personal life.
References
Debs Storey. (2016). Psychiatric interviews for teaching: Anxiety [Video]. University of Nottingham.
Derrick, K., Green, T., & Wand, T. (2019). Assessing and responding to anxiety and panic in the emergency department.Australasian Emergency Care, 22(4), 216-220. Web.
McCabe, R., & Healey, P. G. (2018). Miscommunication in doctor-patient communication.Topics in Cognitive Science, 10(2), 409-424. Web.