Liz Pilapil

How did I engage the patient to complete the interview?

For my project, I interviewed one of the patients on the in-patient service that granted me his

permission. The patient did not have a diagnosis of depression, but he was recently diagnosed

with colon cancer. I thought that the diagnosis could affect his mental state and wanted to find

out more through the interview. We set the interview for one of the evenings when I was in the

hospital.

Describe the setting of the interview.

The interview took place in the patients room. He was one of the patients that was placed

in a single bed room, making it a private place for me to conduct the interview. The patient’s

room was decorated with balloons and cards from his family and friends. He did not look visibly

sick, but I knew that he was diagnosed with colon cancer. He was sitting in the chair next to his

bed and I sat in another chair near him for the interview. We went through the questions pretty

quickly because the patient was always straight to the point with his answers.

Describe your clinical impressions of the interview.

During the interview, my patient answered the questions in a way that led me to believe

that he was not depressed, but not exactly happy either. I don’t believe the test was applicable to

his situation because it asked questions about the future even though his was severely limited. It

was evident that his general appearance was as good as it could be possibly in a hospital. When I

conducted the interview, his social skills, intellect, judgement and foresight were all intact. I was

able to have a sustained conversation with him and he never showed any of the clinical signs of

depression. However, the one thing that I noticed was that he was severely unmotivated to do
Liz Pilapil

anything outside of his room. I am not sure if the lack of motivation was due to a side effect of

his cancer treatments or it was a change in his mood.

The more I spoke with him, the more I realized that he had fully accepted his cancer

diagnosis and was working to enjoy the remaining time he was healthy. However, he said he

often felt like he did not want to leave the hospital room or his house and go outside. A major

reason he felt that he would rather stay home is that he felt weaker and did not want anything to

happen in public. I do not think that this was a sign of depression, but more a concern for his

safety.

Countertransference

I did not know the patient long enough to even have had an opportunity to develop

feelings of countertransference. Furthermore, I do not know anybody who has had a similar

diagnosis to my patient, so I had no way to form a relationship based on the diagnosis. I viewed

the person as a patient and volunteer for my interview, but nothing more than that.

Lack of motivation Try to find patient’s underlying reason for lack of

motivation. Find activities patient used to enjoy and try
to use that to get patient outdoors.

Sadness about diagnosis Give patient options for support groups that exist with
other patients with similar cancers. Have patient speak
to in-patient psych for counseling.

Tiredness Determine source of fatigue, whether it is the cancer

drugs or it is from his state of mind. If it is from cancer
drugs, ask medical team for advice.

End of life care discussions I believe these are very important for a patient with a
poor cancer diagnosis. It is best to start them early so
that the patients initial wishes can be preserved.
Liz Pilapil

Mental Status Exam

1. General Appearance - My patient was dressed appropriately and his hair was combed.

Overall, he looked very clean for being in a hospital

2. Behaviors during the interview - The patient behaved appropriately and was extremely polite

during the course of the interview. Every thing said made it seem like he had a full grasp of

what was going on.

3. Social skills - The patient was a very polite man. He responded to my questions with an

appropriate answer at the right time and tone. He maintained eye contact and made the

proper facial expressions to convey feelings.

4. Motor activity - Speech was at a normal conversational pace.

5. Speech patterns - There was no tangential speech or other deviant speech patterns. He was

able to modulate his tone and was loud enough for me to hear him speak.

6. Concentration and attention span - The patient was able to concentrate on the interview the

entire time I asked for his attention. He never lost focus on what I was asking him.

7. Orientation - Patient was altered to person, place and time. He understand his diagnosis and

said he had already accepted it.

8. Memory - There was nothing to even consider memory impairment.

9. Intellectual functioning - Intellectual functioning was clearly present. The patient knew

exactly what he wanted to do with the remaining time he was expected to have.

10. Affect - Patient was clearly unhappy about his health situation, but it was acceptable

considering his diagnosis. I think it would have been inappropriate if he was overly

optimistic or happy about the future.

Liz Pilapil

11. Mood - Patient admitted he was tired of being at the hospital and excited to get out. He also

admitted to being sad about his future.

12. Thought Clarity - Patients thought seemed clear and alert.

13. Insight - Patient displayed proper insight about the diagnosis and how it would affect his

daily life.

14. Judgement - Patient never made any mistakes in judgement when I was observing him.

15. Motivation - Patient had no motivation to really do anything other than stay in the hospital

room or get home and stay indoors.

Liz Pilapil

16.