OSCE: Postpartum depression
OSCE 16: Postpartum Depression.
Scenario Stem:
You have arrived on your shift at 1800 hours. Your FACEM colleague asks you if you could attend to a 28 year old woman who the charge nurse has highlighted as a concern. The patient wants to leave without prior assessment but the triage note states she is 28, 1st time mother with a 3 month old infant. Her friend brought her after they went to her LMO. The LMO is concerned she is not coping at home, they have assessed the baby on multiple occasions and they are thriving well. Her vital signs are unremarkable and she looks otherwise well.
Your task is to undertake a focused history from Sally and formulate a management plan.
You have seven minutes
Domains assessed:
- Medical expertise
- Health Advocacy
Advice / framework for postpartum depression:
- Apologise for the wait and explain that you are here to help.
- Outline what you wish to talk about.
- Probe for stresses but importantly listen.
- Empathize with what she is going through: “That must be a scary feeling”, “I am concerned by what you are telling me”, “It must be hard for you”, “That can’t be easy”.
- Make a risk assessment about suicide, harm to her baby.
- Look for signs or symptoms of depression.
- Make a disposition plan – likely the mother and baby unit. If she lacks some insight, use her baby as a reason. “I know you are concerned about your baby and this way we can monitor how he is feeding and also provide you with some support and sleep at the same time”.
Additional comments / Resources on this video:
- Full of amazing lines.
- Just missed the PMH but added it second time round with some new insights.
- Below are just a few other suggestions:
- I feel like he’d be better off without me – “What do you mean by that”, “That’s concerning to me, have you ever thought about harming yourself or Ben?”
- I feel I am wasting your time – “What you have is really serious and is as serious an illness as anyone can have”.
Examination Library
ACEM
Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.
2 Comments
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Thanks for the videos.
But should you also cover following?
1. Pregnancy, complications
2. More features of depression – attention, concentration, guilt, negative view of future etc.
2. DDx – organic pathology – Anaemia, Hypothyroid
3. DDx- post partum psychosis, thoughts of harming the baby
Or is it ok to keep focus on only the obvious and give time for counselling and talk slowly and empathic within 7 mins?
These are great thoughts. The videos are not necessarily ‘the model answer’ but something that would pass. If you have time to explore your other suggestions I would. If time is running out you can always drop a line like: ‘I see we are currently short of time so I’d like to sumaries my plan… and you can add in your investigations for your differentials in that.. and say I would like to come back and have a longer conversation about…(maybe that’s more features of depression). I hope that helps. Try not to get too bogged down trying to get everything out in the exam as you may run the risk of sounding like you are going down a checklist. Be empathetic, be yourself. The examiners want to see if you’d be a colleague they would work with and not a dangerous clinician.