Coach: Your goal is to determine if Antoine is at risk for a mental health disorder. Ideally you should be able to complete this screening in three to five minutes. Afterwards we’ll discuss your approach and how long the screening took.
Pic 0: The title card appears, then the screen fades to an exam room where Austin sits with his computer across from a man named Antoine.
Austin: Good morning, Antoine. I’m Austin. It’s nice to meet you.
Antoine: Hi.
Austin: I see you’re here today for back pain. Can you tell me more about it?
Antoine: Yeah, I’m having this pain in my lower back. It’s really bad. Pretty much hurts all the time. I can barely work. I really just need some meds for it.
Hurt it a while ago and I was taking Percocet. That made it feel better. But I ran out, so I just thought I’d come in, get some more.
Austin: I'm sorry to hear you're in pain. Does the pain travel down into your buttocks, into your hip or lower leg?
Antoine: A little down my legs, but mostly just in my lower back. Hurts to stand, it hurts to walk, it hurts to climb the stairs. It's a sharp, burning pain.
Austin: I understand. Back pain can be really bothersome.
Antoine: No offense, but this pain is god-awful. It's more than just "bothersome."
Austin: You're right, I'm sorry. Well, let me ask you some questions to learn more about your situation.
Antoine: Okay.
Coach: By calling his pain "bothersome," Austin made Antoine defensive, giving him the impression that Austin doesn't fully understand the severity of his pain.
Austin: So, when you first injured your back, who gave you the Percocet?
Antoine: Uh, I saw this doctor a while back because I tweaked my back carrying some heavy stuff. He gave me some Percocet, and it worked like a charm.
Austin: Did that provider do any x-rays or a MRI?
Antoine: Yeah, they said it was a herniated disc or something. I don't really remember, but now it's hurting again and I've gotta get this fixed so I can get back to work.
Austin: Dr. Singh is gonna come in and examine your back, and then we'll talk about what to do to help you feel better.
Coach: Provider’s Exam Results: Antoine's pain is in his lower back, down into his legs, described as sharp and burning. No numbness or tingling. Standing, walking up the stairs makes it worse. Back flexion and decreased side flexion with bending to the right worse than the left. Point tenderness along the thoracic and lumbar spine and left and right lateral to it across the whole area. No tenderness in hips or buttocks, negative leg lifts, normal lower extremity reflexes. Normal motor strength and sensation but pain with the hip flexion and rotation.
Austin: How long ago did you injure your back?
Antoine: About eight months ago.
Austin: So you've been taking the Percocet ever since?
Antoine: No. My prescription ran out a few months ago. Then I got some here or there from my buddies, you know it's the only thing I've tried that works, which is why I came in.
Antoine’s thought: My buddies are all running out of their meds, too.
Austin: Antoine, acquiring Percocet without a prescription, even if you're getting it from friends, is illegal. You shouldn't do that!
Antoine: If you're not gonna help me, alright then, no problem, I'll take care of it myself.
Coach: Austin giving his opinion about Antoine's illegal use of Percocet made Antoine feel judged. Instead, Austin should save his opinion until later in the conversation, when Antoine's more comfortable with Austin. Let’s look at a more effective approach.
Austin: Well, the Percocet will help the pain for periods of time, but it won't make your back better.
Antoine: So you're not gonna give me any Percocet then?
Austin: Dr. Singh may not feel comfortable writing a prescription until we see what's going on, and then we can work together to make a decision.
Antoine: Alright, that sounds good, but I really have to get back to work. So, as long as it's gonna be quick.
Antoine’s thought: Why can't anything just be easy. I hope I don't have to go to another doctor to get this prescription.
Austin: Did something happen recently to make the back pain worse?
Antoine: (laughs). Yeah. You're gonna think this is crazy but a few weeks ago I fell out of bed while I was sleeping and I landed smack on my lower back. I know, right, it sounds crazy.
Austin: Have you had problems falling out of bed in the past?
Antoine: Well, I, um. I'm sorry, could, could you repeat that?
Austin: Have you ever fallen out of bed before?
Antoine: No, this was the first time. I was just having one of my nightmares, you know?
Coach: Seems like Antoine was distracted for a moment. Austin should be aware as he’s continuing to speak with Antoine and continue to look for other times in which he may have trouble concentrating.
Antoine’s thought: So embarrassing. Falling out of bed and hurting myself like an old man.
Austin: That must have been a horrible nightmare to make you fall out of bed like that. How frequently do you have nightmares?
Antoine: Well, my wife says that I have them a lot because it wakes her up and she sees me flailing around and stuff, and, you know, I'm sleeping like crap, and I'm tired so I guess it makes sense.
Austin: What are they like?
Antoine: Well, you know, I served in Afghanistan, so, you know, I have plenty of ugly pictures floating around in my head.
Austin: So the nightmares are about your time in the service.
Antoine: I think so. Sometimes it's like images from Afghanistan and other times it's just weird, like being chased or someone is trying to kill me, but I never see them.
Coach: Veterans are a particularly at-risk population because they have a higher likelihood of experiencing trauma, which is a risk factor for PTSD and other mental health disorders.
Austin: How does your back pain affect your sleep?
Antoine: Yeah, I mean that's what I'm saying here. My back hurts all the time. My sleep is terrible, that's what I'm trying to tell you. I need this medication because it helps me sleep, it helps me with my back.
Austin: So, in addition to helping with your back pain, the Percocet also helps you sleep better.
Antoine: You got it.
Coach: Austin did a great job summarizing what Antoine says and showing him that he’s listening. Antoine seems to be using Percocet not only to manage his pain, but also to help him sleep better. This could be an indication of a substance use habit.