John R., a 29-year-old man separated from his wife, walked into the health maintenance organization (HMO) stating he had a severe sore throat could not eat, had not worked for a day. and was feeling “awful ’ He wanted to see the doctor and get a prescription for an antibiotic. The medical record revealed two episodes within the last 9 months of complaints of a sore throat. culture of organism, and antibiotic treatment The separation from his wife occurred 1 year ago. He had not had a physical in 2 years During the assessment inter-
view, the nurse gathered the following information: John R appeared tired he presented his problem ,n short, terse statements; he was irritable about the clinic’s slow service; and he expressed a need to get back to work Within the last 3 weeks, he had been required to work overtime because he faced deadline penalties, and his boss said that John R ‘s promotion, due in 2 months, depended on his performance now The company is struggling and layoffs may be pending John R said that, in general, things were fine His wife was