Redundant Question

"Books are written by those who have nothing better to do" - Gynae Prof.

On the same token, Guidelines are probably made up by those who had even less to do. They are useful in some situations, but definitely not the most practical things. The mnemonics are great for quick recall of what prompting questions need to be asked, but you wont always get to the bottom of your mnemonic though.

I had a patient come in today with chronic lower back pain (20 years) that drives him absolutely up the wall and depressed. Pain killers does little for him, and he doesn't believe in the value of antidepressants. He's come in with a shoulder pain that's been brewing for over a month, and said all the pain has made him suicidal. Alarm bell rang in my head. Since he has the ideation, I need to ask about plan, and lethality if any. So I explained that I ask every suicidal patient whether they have a plan.

He squinted his eyes and whispered under his breath,

"I don't need a plan."

"huh?"

"I was trained as a sniper in the army, and we were trained so that if we ever fall in enemy hands, there'd be no live snipers to answer questions. So I've been trained to kill myself."

He then went on to tell me how he can weaponise my pen in my front pocket, the glass on my watch, his watch, my stethoscope, and several innocent objects in the room.

I was gonna ask if he had the means to carry out the plan (e.g. like a gun in the house or something), but I thought that was redundant.