FGHL Kate CallaghanMr. B is a middle-aged man who was following up with us after an acute visit about three weeks ago for chest pain, which, at the time, was thought to most likely be due to acid-reflux. It was clear as I spoke with him that afternoon that while his reflux-related pain had subsided some with the addition of a medication, he still wasn’t feeling like himself.

He couldn’t really pinpoint any symptoms other than some persistent burning below his sternum, but with every question I asked, he would give a two to three minute response in which he’d more or less describe normal functioning.

After this had happened two or three times, I was hesitant to ask another question, mindful that a physician was waiting on the other side of the exam room door and doubtless had other patients besides Mr. B that were either already roomed or arriving soon. But I hadn’t yet asked Mr. B about his mood and whether or not he thought this might be contributing to his symptoms.

So as he concluded his response to a question about changes in his eating habits, I asked: “Mr. B, are you feeling stressed at all? How has your mood been lately?” With this question, his face softened a bit, he looked down for a moment, and then he said: “You know, I’m having a lot of stress in my relationships.”

He proceeded to talk about his living situation, a new romantic relationship, and hard interactions at work. He noted that he was open to talking with our behavioral health consultant (BHC), and he agreed to fill out the depression and anxiety assessment tools that we have in the clinic to see how severe his symptoms were.

In his interaction with the BHC, Mr. B revealed that he had an extensive history of trauma. He had received help from a faith-filled mentor, which had allowed him to heal in tremendous ways. However, even with that, he acknowledged that the combination of his history and his present struggles likely merited an appointment with a professional counselor.

Hearing these thoughts, the BHC provided him with information about resources that might be convenient for him. Mr. B asked some questions, and then he paused. Looking at the BHC he said, “I just don’t want to do this. I know I need to, I just don’t want to.”

The BHC responded saying: “You know, none of us wants to show up at someone’s door and say, ‘I have a problem that I can’t handle by myself.’ But the reality is that, every single one of us needs that. If we all had the time and the money, every one of us would be in counseling. We all need it.” At that, Mr. B gave a half grin and said, “Okay. I’ll check it out.”

I left this encounter struck by the depth of what had just happened. Mr. B clearly had something to say from the second I walked in the exam room. But my bias towards efficiency nearly stopped me from asking the question he really needed to answer. As I reflected on the interaction, I realized how much power I had in that conversation.

I don’t think Mr. B would have mentioned his relational struggles had I not asked about his mood, and I’m not sure he would have seen the BHC and been given the resources he needed had he not voiced those relational challenges. While a refill of his medication may have helped alleviate a little more of his abdominal discomfort, it would not have addressed an equally (if not more) important underlying issue, his mental and emotional health, themselves a potential cause of his physical pain.

Kate Callaghan is a Frist Global Health Leader working at the Siloam Family Health Center with refugee, immigrant, and other underserved individuals.