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  #1  
Old 01-19-2011
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Medicolegal and Ethics Ethics question; Man lost his wife and is drinking

A 62-year-old man comes to the physician with a 3-month history of fatigue and depression. He lives alone and has been drinking more (up to 6 mixed alcoholic drinks daily) since his wife of 40 years died 6 months ago. He says, "Yeah, I know I've been drinking a lot lately, but I'm so down in the dumps there's nothing else I want to do. I miss her so much. " Which of the following responses by the physician is most appropriate?



a) "Anybody in your circumstance would be depressed. Time will help you overcome the loss of your wife."

b) "Drinking isn't going to bring your wife back. You need to get on with your life and put this sad experience behind you."

c) "I know you have been through a lot recently. Have things been so bad recently that you have thought about killing yourself."

d) "I'd like to start you on some medication for depression. It sometimes takes a few weeks to work."

e) "You seem to be developing an alcohol problem. You need to quit drinking. I can refer you to the local chapter of Alcoholics Anonymous."
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  #2  
Old 01-19-2011
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i would go with D cuz in the question they specifically mentioned 6 months since his wife died ....so i am assuming he is in depression .....correct me if i am wrong
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Old 01-19-2011
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A. sounds good, you are expressing empathy, could be a possibility
B. sounds a little critical.
C. Seems very right, he is in the high risk age group for suicide, alcoholism and death of spouse rank pretty high for risk factors, so it wouldnt hurt to make sure he isnt having suicidal thoughts. you are finding more information.....
D. Seems too early to medicate without figuring out what the problem is (Alcoholism vs Depression vs Grief), and besides you and patient must arrive on a consensus or similar plane of understanding before you medicate. and if you medicate grief, you prolong it.
E. AA - this man has insight into his problem , he seems to admit he has a drinking problem. AA would be the right choice if drinking was his primary problem but he is grief, dont know AA works well here.

I would guess C.
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Old 01-19-2011
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I'm guessing C - to gauge how severe his depression is and therefore how to proceed with treatment. It's important to ask every patient with depression this question. Because what is he had suicidal thoughts and you let him go away with one of the other options...
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Old 01-19-2011
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Default C.

I agree with drbluedevil and Shibtag. He may be depressed or not - normal grieving can last up to one year, but suicidal ideation is a criterion. Heavy drinking is dangerous, so sending him away would likely not be a correct answer choice on the boards. C is the only one that helps us arrive at a diagnosis.
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Old 01-20-2011
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i think its B..its good to start his treatment after giving him some sort of emotional sympathy...correct me if im wrong.
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Old 01-24-2011
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in question they said depressed so we afraid from suicide idea ( choice C )

but also he have a problem with alcohol and you should tell him ( choice D )


so iam confused with C OR E

N.B : depression is pathological grief.


normal grief ( duration 6 month- 1 year )
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Old 01-24-2011
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i'll go with C.
He is depressed, he lives alone, he is dev an alcohol problem. The next best thing is to determine suicidal intent.
The combined suicidal risk is over 30%.
Besides, choice C is the only one that first gave support to his situation, before proceeding.
Choice D is not likely because, refering him is not urgent, he culd have killed himself before getting there.
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  #9  
Old 01-24-2011
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Quote:
Originally Posted by tunde michael View Post
i'll go with C.
He is depressed, he lives alone, he is dev an alcohol problem. The next best thing is to determine suicidal intent.
The combined suicidal risk is over 30%.
Besides, choice C is the only one that first gave support to his situation, before proceeding.
Choice D is not likely because, refering him is not urgent, he culd have killed himself before getting there.


what about choice E ( i am confused between C and E)
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Old 01-24-2011
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choice E is not likely, because the information provided in the question is not enough for an alcohol problem(abuse or addiction), to warrant referral to Alcoholics Anonymous. The man is aware of his increased alcohol use, and once suicide intent is ruled out, depression is addressed, he will reduce or stop alcohol use.
The question tends more towards depression and suicidal intent..
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