22. Staying with a patient without a diagnosis
Clinicians with complex patients Planned episode, the physician. Staying with a patient through uncertainty.
Listener title: Staying with a patient when there is no diagnosis
Listener description: A psychologist or psychiatrist from the network's counselor roster talks through how physicians can stay with a patient when a thorough workup has not produced a diagnosis. The episode covers language that helps, boundaries, and when and how to bring in behavioral health. For clinicians who care for complex patients over years.
Run of show (about 40 minutes)
| Time | Segment | What happens |
|---|---|---|
| 0:00 to 2:00 | Opening | The host introduces the theme and the guest's role, and restates the ground rules: no patient information, and cases come up only as problems, without the patient. |
| 2:00 to 5:00 | Guest and disclosures | The guest describes their practice and how they work alongside primary care and specialty physicians, and discloses any industry relationships. |
| 5:00 to 14:00 | Language that helps, and language that doesn't | The guest describes phrases they have seen keep a patient engaged after an unrevealing workup, and phrases that tend to end the relationship. The host asks how to say "we don't know yet" without implying "nothing is wrong," and how to write that uncertainty in a note so the patient and the next clinician read it the same way. |
| 14:00 to 23:00 | Boundaries | The guest explains how they think about visit frequency, messages between visits and requests for more testing, and how to hold a boundary while saying why. The host asks how boundaries change in a cash-pay or membership practice, where access is part of what the patient pays for. |
| 23:00 to 33:00 | Bringing in behavioral health | The guest explains when they think behavioral health should come in, and how to word the referral so it is heard as added support while the medical question stays open. The counselor roster page cites the USPSTF recommendation to screen all adults for depression (grade B); the guest explains how a screen offered to every patient can be framed differently from a referral prompted by unexplained symptoms. |
| 33:00 to 37:00 | Sharing care afterward | The guest describes what they send back after seeing a referred patient, and what they need in the referral to be useful. |
| 37:00 to 40:00 | Closing | One practical takeaway from the guest: when behavioral health is added, say and write that the medical question remains open. Listeners can reach the network at hello@coloradocarenetwork.com, and physicians can use the interest form at coloradocarenetwork.com/join. |
Guest prep questions (sent to the guest a week ahead)
- When a workup is unrevealing and symptoms continue, which phrases have you seen help a patient stay engaged, and which tend to end the relationship?
- How would you suggest a physician document uncertainty so that the patient, reading the note, and the next clinician understand it the same way?
- What boundaries do you recommend around visit frequency, messages and requests for more testing, and how do you hold them without the patient feeling dismissed?
- When do you think behavioral health should come in, and how should the referral be worded so it reads as support rather than a conclusion about the symptoms? How does routine depression screening fit into that conversation?
- When a physician refers a patient to you, what do you need in the referral, and what do you send back so care stays shared?
Show notes
A psychologist or psychiatrist from the counselor roster and the host discuss how to stay with a patient whose thorough workup has not produced a diagnosis. They cover the language that keeps the relationship intact, boundaries on visits, messages and testing, and when and how to bring in behavioral health. The counselor roster page cites the USPSTF recommendation to screen all adults for depression, and the guest explains how routine screening differs from a referral prompted by unexplained symptoms. The episode closes on how the guest and the referring physician share care afterward.
- Sources: US Preventive Services Task Force; Barry MJ, Nicholson WK, Silverstein M, et al. Screening for depression and suicide risk in adults: US Preventive Services Task Force recommendation statement. JAMA. 2023;329(23):2057-2067. doi:10.1001/jama.2023.9297
- No patient information is discussed on this episode.
All planned episodes. To be the guest for this episode, email hello@coloradocarenetwork.com with the episode number.