W. Clay Jackson

Assessing and managing pain and major depression with medical comorbidities.

Chronic pain is the leading reason patients see their primary care physician, and the burden of pain and depression in those with medical illness is particularly severe. Improving depressive symptoms can decrease physical symptoms in many patients, but these patients may require a different treatment strategy than those with depression alone. This activity provides guidance on recognizing and accurately diagnosing pain and major depression, managing these conditions using assessment tools and measurement-based care, avoiding unwanted side effects and drug interactions, and properly matching patients to appropriate treatments.

Resolving Residual Symptoms in Primary Care Patients With Depression

In this CME podcast, listen to experts discuss the case of Mrs J, an elderly woman with a history of depression. She has reported insomnia and has requested a benzodiazepine to help her sleep. Although she claims that her depressed mood is well controlled, her husband reports differently. The experts review her treatment options, taking into account both her symptoms and her age.

Saving Time With Measurement-Based Care for Depression in Primary Care

In this CME podcast, listen to experts discuss the case of Mrs C, a 38-year-old married woman with depression who does not respond to initial antidepressant treatment. Next-step strategies for identifying the cause of nonresponse and tips for how to best monitor patients are given.

Improving Adherence in Primary Care Patients With Depression

In this CME podcast, listen to experts discuss the case of Mr K, a healthy 28-year-old man who has never needed medical care previously. He has recently lost his job and developed a major depressive episode that has complicated features. The experts review his objective screening and monitoring instrument results as well as possible steps to take that will help alleviate Mr Ks problematic symptoms.

Using clinical empowerment to teach ethics and conflict management in antemortem care: a case study.

Although the concept of palliative care has made substantial gains in US medical systems since the mid-1990s, gaps remain in the delivery of high-quality antemortem care. For instance, in many areas of the country, palliative care remains largely confined to those patients with malignancy, leaving terminally ill patients with nonmalignant diagnoses few choices outside the traditional curative model of care. For physicians, understanding prognoses in this population is fraught with difficulty, since patients without malignancies tend to follow a trajectory of acute exacerbations with near-recoveries, rather than a precipitous, predictable decline in function. For patients and families, this uncertainty is compounded, presenting challenges for obtaining clearly defined advance directives and for achieving healthcare commensurate with those given directives. Although efforts are moving forward to elicit patient wishes and consider them at the point of antemortem care, there is relatively little research on the interface between patients’ wishes and those of the family. We report a case in which the wishes of a terminally ill patient (without malignancy) were at variance with those of her family, and the patient’s rapidly deteriorating condition rendered her unable to again express her previous directives. We used a nominative process during a medical team meeting to reach a consensus on which path to take, then allowed our fourth-year student and senior resident to lead a conference involving the family and the medical team. A larger consensus was reached, breached, and regained, allowing learners ample opportunities to practice negotiation skills, as modeled by faculty. Regular team meetings to debrief about developments in the case allowed team members the opportunity to share perspectives on antemortem care, to gain knowledge, and to examine their attitudes toward caring for dying patients.