Saw a patient. A long time ago in a galaxy far far away....
Two complaints: foot pain and depression.
"I made the appointment for foot pain. But... the depression is getting worse, really bad the last week."
Seeing counselor? Yes.
Check in on family mess? Still a mess.
What do you want your life to look like? (overwhelmed silence)
"I want to be happy. Not miserable."
Rule out suicidal. The pursuit of happiness is a right: but you won't catch it.
"But I am miserable all the time."
I am this person's family doc. And thorough. And I remember shit that worries me.
"How much alcohol are you drinking?" The chart says two drinks two nights a week.
"Well.... about three drinks at night."
"It's a depressant."
"I can't sleep! I have a couple of drinks and then I am happy for a bit and I can relax and sleep!"
"So you are depressed and you don't want to change the depressant that you are taking."
"I can't sleep! It's the only way I can sleep!"
It's been eight months since I last saw him. "You are telling me you are miserable most of the time. I can probably help with sleep with something that isn't a depressant. But you have to be willing to work at it."
"My ankle really hurts. If I could exercise."
Ok. We will xray the ankle and set up a follow up.... for ankle pain and insomnia....
change the subject:I want you back