Telephonic Consultation for Postpartum Depression: Comprehensive Data Gathering and Management

Introduction and Initial Steps

• Identify the Patient:

• Ask for the patient’s name to ensure you are speaking to the right person.

• Confirm it is a good time for the consultation.

• Verify other identifiers (age, first line of address).

• Backup Plan for Disconnection:

• Ask if the line is reliable or if there is an alternative contact number in case of disconnection.

Main Consultation

• Presenting Complaint:

• Use existing information to save time (e.g., “I see you have problems with sleep. Can you tell me more about this?”).

• Elaborate on the complaint by differentiating between difficulty falling asleep and staying asleep.

• Explore History and Context:

• Investigate if the sleep issue is a new problem or ongoing.

• Discuss any triggering events, such as recent childbirth.

• Duration of Symptoms:

• Ask how long the patient has been feeling this way to differentiate between baby blues and postpartum depression.

Rapport Building

• Acknowledgement and Empathy:

• Congratulate the patient on the birth of their child.

• Acknowledge any signs of distress or unusual behavior.

Detailed History Taking

• Pregnancy and Postpartum Period:

• Ask about the pregnancy and childbirth experience.

• Inquire about the baby’s health and any abnormalities.

• Self-Assessment:

• Understand the patient’s mood and energy levels.

• Ask about anhedonia (loss of interest in previously enjoyable activities).

Safety and Risk Assessment

• Depression and Self-Harm:

• Signpost before asking about self-harm and harm to the baby.

• Ensure to address postpartum psychosis symptoms (hallucinations, intrusive thoughts).

• Past Medical and Family History:

• Collect information on past medical history, medications, and family support systems.

• Assess daily activities and coping mechanisms.

Investigation and Diagnosis

• Invite for Physical Examination:

• Suggest a GP visit for further examination and tests (e.g., TFT, LFT, CBC, RFT).

• Breaking the News:

• Gradually inform the patient about the diagnosis (postpartum depression).

• Tailor the explanation based on the patient's reaction.

Treatment Plan

• Therapies and Medications:

• Propose talking therapy, self-help strategies, yoga, and meditation.

• If clinical depression is diagnosed, explain the need for medication (e.g., Sertraline).

• Medication Details:

• Discuss the important side effects of the medication.

• Explain that the patient may not see immediate effects; the medication typically starts showing effects within 3-4 weeks.

• Emphasize the importance of continuing the medication for at least six months to ensure effectiveness.

• Additional Support:

• Offer to connect the patient with social services or support groups (e.g., PANDAS, APNI).

Conclusion and Follow-Up

• Safety Netting:

• Provide a crisis plan with a 24-hour helpline number for emergencies.

• Follow-Up:

• Schedule a follow-up appointment in two weeks to review progress and make necessary adjustments.

• Information and Resources:

• Provide leaflets and pamphlets for additional information and support resources.

Essential Reminders

• Always establish a clear understanding of the patient’s context and history.

• Maintain empathy and build rapport throughout the consultation.

• Ensure thorough safety assessments and provide detailed follow-up plans.

• Utilize all available resources and support systems to aid the patient’s recovery and well-being.