Tomorrow afternoon, the last 20% of my psychiatry rotation’s grade will be determined based on my ability to watch a 30 minute videotaped patient encounter, prepare a presentation, and then orally deliver the case with an accurate differential diagnosis and treatment plan.
Aside from the typical introduction (history of present illness, past psychiatric/medical history, medications, etc.), I’ll have to discuss the patient’s mental status exam (MSE) and formulate a biopsychosocial (BSP) approach to the diagnosis. I wanted to outline how the BSP approach, a theory which is rooted in the notion that the mind affects the body and vice versa, is a fantastic way to explore a psychiatric patient’s situation.
The BSP approach is just that – figuring out how a patient’s biology, psychology, and his or her social situation predispose, precipitate, perpetuate, and protect an individual in the context of illness and health. Here’s a table (credit goes to an unknown psychiatry resident) which helps me categorize facets of a patient’s history.
Looking over this table, it’s easy to see that we’re not dealing with the mundane “underlying problem -> symptoms -> treatment” approach to medicine. Instead, all aspects of a patient’s life are considered, and it’s the interplay between these which dictates how we should best go about diagnosing and treating.
Over the last two months, I’ve not *formally* presented the BSP in my notes, but it’s an inherent part of every diagnosis (especially psychiatric), so I should be okay in theory. 😉 Hope I can pull through tomorrow!