Conducting a mental status exam can be tougher than we think, particularly with highly defensive or even combative patients in acute distress. In order to be thorough, we must be persistent; but persistence without empathy can potentially alienate our patients. In this video, we are presented with two informative scenarios that contrast inexperienced and experienced interventions with a young woman hospitalized after a recent suicide attempt. Here, you’ll witness the palpable difference that transparent communication, assertive rapport, and humor can make in this essential therapeutic task.

In each vignette, Sue stops in to interview Kristy, a patient with Borderline Personality Disorder who wants to change doctors and leave the hospital as soon as possible to attend to her son. Nervous, stiff, and timid in the first scenario, Sue’s neophyte attempts to engage Kristy quickly fall flat. The nurse is easily steamrolled by Kristy’s anger, and her failure to adequately empathize or keep the interview on track only intensifies her patient’s distress.

The second vignette features a much more assertive, confident, and approachable Sue, who immediately takes charge while using light humor and a matter-of-fact tone to focus the conversation. Sue gives Kristy reflective statements, leverages her desire to see her son as a reason to complete the exam, and enlists her input to better understand her priorities. Though Kristy still challenges her, she is clearly more contained by Sue’s skilled interventions, opening up about her feelings and challenges and allowing Sue to offer options for social support during her recovery.

Whether done formally or informally, mental status exams uncover material necessary for successful treatment, so learning to conduct them thoroughly, even amid strong patient resistance, is crucial. If you’re looking to enhance your own skills in this area, this video is a must-watch.