Margaret Chisolm, MD, Johns Hopkins University School of Medicine
An essential feature of a systematic psychiatric evaluation is historical information obtained from multiple sources – individuals (e.g., family, friends, other clinicians) who know the patient or some aspect of the patient well.
The primary purpose of talking to other people who know the patient is to expand on and enhance the history that the patient provides, as the patient’s point of view can be limited and/or skewed for various reasons, including psychiatric illness. For example, a depressed mood could affect the patient’s recounting of their life story and make aspects of the history inaccurate; it could lead the patient to distort memories of past feelings and events.
A clinician needs to obtain information from a variety of sources in order to understand how others see the patient and the patient’s history. This enables the clinician to form a more complete understanding of the patient and their condition.
From my decades of experience evaluating patients previously assessed by other clinicians, I have found that most other mental health clinicians do not gather information from additional sources. Yet, they should.
I encourage patients to find a clinician who includes a friend, family member, and/or another clinician in their psychiatric evaluation, even if the patient is an adult seeking individual outpatient psychotherapy.
In fact, being in individual psychotherapy with a clinician who does not understand the patient in the context of their history hampers the psychotherapy from the outset and represents a risk to the patient and their mental well-being.
In my experience, most patients and their family members are receptive to and appreciative of these discussions. Early on in my career, I did not always made these contacts as part of the initial evaluation, but –over time – have come to appreciate their value in understanding the nature and origin of my patients’ troubles.
Panagis Galiatsatos, MD, Johns Hopkins University School of Medicine
I always confirm that the patient is happy with their family and friends staying in the room.
Next, I always love receiving collateral information on a disease or condition, so, with the patient’s blessing, I ask the family members for additional insight.
Finally, I make sure everyone’s questions and comments are answered and addressed.
Most important for me, I make sure the family and friends recognize they are as important to the patient’s disease management as any of my treatments. A strong social support is imperative to the patient’s outcome.
What do you think?
Do you want to add to the conversation? Please share!
Rachel Salas, MD, Johns Hopkins University School of Medicine
In sleep clinic, the person in the room is typically the “witness” and is an important historian, so hearing their input is very important.
The person in the room may be the caregiver. Engaging them in decisions can be helpful in providing the best care for patients as they can help ensure that the recommendations are followed at home. They can also provide insight on things at home that could be obstacles in the care of the patient
Javier de la Maza, MD, Johns Hopkins University School of Medicine
Whenever a patient comes with family members or a friend, I always try to take advantage of the situation. After all, it’s an opportunity to gather information about the patient’s habits that I wouldn’t be able to get, otherwise.
At the beginning, I always try to keep my attention on the patient, at the same time I acknowledge the importance of the companion. I also try to use verbal and non-verbal communication to set some boundaries during the clinical encounter.
After I’ve taken enough time to assess the nature of their relationship, I try to include the other person and ask their opinion, if it’s appropriate. I think it’s important to finish the encounter with an open discussion eliciting input from the patient and their love one.
Tina Zhang, MD, Johns Hopkins University School of Medicine
My patients frequently come to their visits with family and/or friends. I like to direct specific questions to the family member or friend to include them in the conversation. Frequently, the family member knows more about the patient’s health than the patient! I have found that including family members in the conversation leads to more shared decision making.
